| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
451 |
446 |
$22K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,089 |
1,083 |
$21K |
| V2020 |
Frames, purchases |
617 |
614 |
$19K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
379 |
376 |
$17K |
| 92015 |
Determination of refractive state |
118 |
118 |
$1K |
| 92341 |
|
43 |
43 |
$988.14 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
78 |
76 |
$706.51 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$566.40 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$479.99 |