| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,856 |
2,823 |
$116K |
| V2020 |
Frames, purchases |
3,819 |
3,731 |
$55K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,501 |
2,401 |
$39K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,678 |
2,659 |
$35K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
461 |
459 |
$20K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
644 |
623 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
565 |
558 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
118 |
115 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
26 |
26 |
$0.00 |