| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,315 |
2,280 |
$109K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,790 |
1,776 |
$83K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,679 |
3,570 |
$70K |
| V2020 |
Frames, purchases |
2,614 |
2,588 |
$68K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,417 |
1,365 |
$22K |
| 92341 |
|
686 |
658 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
25 |
25 |
$445.39 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
827 |
814 |
$192.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$163.61 |
| 92015 |
Determination of refractive state |
12 |
12 |
$56.45 |
| V2750 |
Anti-reflective coating, per lens |
55 |
53 |
$0.00 |