| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,659 |
1,587 |
$82K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
948 |
937 |
$53K |
| V2020 |
Frames, purchases |
1,719 |
1,614 |
$30K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
680 |
660 |
$29K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
387 |
333 |
$16K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
193 |
170 |
$6K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
74 |
74 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
60 |
60 |
$3K |
| V2025 |
Deluxe frame |
82 |
82 |
$974.16 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
16 |
16 |
$720.00 |