| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,796 |
1,776 |
$53K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
979 |
975 |
$47K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,255 |
2,243 |
$45K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
784 |
781 |
$36K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
563 |
548 |
$32K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
324 |
322 |
$22K |
| 92341 |
|
813 |
805 |
$18K |
| 92250 |
|
469 |
443 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
908 |
899 |
$10K |
| 92015 |
Determination of refractive state |
880 |
867 |
$9K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
223 |
220 |
$4K |
| V2204 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
279 |
277 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
27 |
25 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
17 |
17 |
$904.12 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
41 |
41 |
$768.96 |
| D1110 |
Prophylaxis - adult |
17 |
17 |
$375.70 |
| V2756 |
Eye glass case |
1,003 |
999 |
$268.92 |