| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,119 |
1,048 |
$46K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,075 |
1,023 |
$45K |
| V2025 |
Deluxe frame |
1,135 |
1,070 |
$41K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,110 |
1,159 |
$19K |
| V2020 |
Frames, purchases |
1,084 |
944 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,444 |
1,419 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
968 |
462 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
180 |
111 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$854.78 |
| 92015 |
Determination of refractive state |
163 |
149 |
$321.86 |