| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,640 |
1,629 |
$70K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
731 |
728 |
$32K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,400 |
1,381 |
$28K |
| V2025 |
Deluxe frame |
870 |
868 |
$21K |
| V2020 |
Frames, purchases |
857 |
837 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
650 |
643 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
185 |
185 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
38 |
38 |
$606.10 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$405.00 |
| 92015 |
Determination of refractive state |
15 |
15 |
$140.00 |