| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
161 |
159 |
$7K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
110 |
107 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
174 |
163 |
$3K |
| V2020 |
Frames, purchases |
167 |
158 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$20.58 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
24 |
$0.00 |