| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,562 |
1,533 |
$73K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,569 |
1,532 |
$70K |
| V2020 |
Frames, purchases |
2,440 |
2,383 |
$55K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,534 |
2,466 |
$48K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
134 |
132 |
$3K |
| V2750 |
Anti-reflective coating, per lens |
104 |
103 |
$2K |
| 92250 |
|
1,115 |
1,068 |
$2K |
| 92015 |
Determination of refractive state |
92 |
91 |
$155.51 |
| 99199 |
Unlisted special service, procedure or report |
40 |
40 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
47 |
46 |
$0.00 |