| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
815 |
748 |
$31K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
787 |
752 |
$31K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
368 |
366 |
$10K |
| V2020 |
Frames, purchases |
387 |
382 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
20 |
17 |
$87.50 |
| 92015 |
Determination of refractive state |
36 |
31 |
$0.00 |