| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,121 |
1,066 |
$76K |
| V2020 |
Frames, purchases |
2,301 |
2,183 |
$74K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
404 |
389 |
$26K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
819 |
781 |
$24K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
207 |
185 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
81 |
77 |
$3K |
| 92015 |
Determination of refractive state |
128 |
127 |
$2K |
| 92310 |
|
16 |
15 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$910.45 |