| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
260 |
249 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
92 |
82 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
294 |
285 |
$6K |
| V2020 |
Frames, purchases |
352 |
338 |
$6K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
90 |
72 |
$3K |
| 92015 |
Determination of refractive state |
294 |
272 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
60 |
59 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
16 |
13 |
$830.09 |
| V2025 |
Deluxe frame |
13 |
13 |
$668.11 |
| 92060 |
|
63 |
61 |
$388.83 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
54 |
51 |
$0.00 |