| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 65778 |
|
873 |
866 |
$63K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
716 |
689 |
$31K |
| V2020 |
Frames, purchases |
1,549 |
1,482 |
$28K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
528 |
513 |
$23K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
838 |
804 |
$12K |
| 99336 |
|
362 |
352 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
300 |
286 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
505 |
503 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
154 |
148 |
$4K |
| 92015 |
Determination of refractive state |
232 |
223 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
42 |
42 |
$2K |
| 92250 |
|
156 |
151 |
$1K |
| V2206 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens |
34 |
28 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
94 |
92 |
$928.84 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$137.55 |
| 92285 |
|
39 |
38 |
$101.73 |
| 92100 |
|
24 |
24 |
$44.84 |
| 68801 |
|
30 |
29 |
$43.68 |
| V2755 |
U-v lens, per lens |
25 |
25 |
$30.00 |
| 92273 |
|
34 |
31 |
$0.00 |