| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
885 |
853 |
$36K |
| V2020 |
Frames, purchases |
1,611 |
1,526 |
$36K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
567 |
554 |
$23K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
835 |
784 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
659 |
632 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
598 |
561 |
$10K |
| V2025 |
Deluxe frame |
30 |
28 |
$980.16 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
62 |
58 |
$913.81 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
15 |
15 |
$498.01 |
| 92015 |
Determination of refractive state |
55 |
54 |
$265.21 |