| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,346 |
1,183 |
$45K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
928 |
800 |
$32K |
| V2020 |
Frames, purchases |
1,746 |
1,593 |
$22K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,044 |
954 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
516 |
472 |
$9K |
| V2025 |
Deluxe frame |
256 |
226 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
300 |
272 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
59 |
58 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
46 |
29 |
$635.25 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
52 |
50 |
$583.83 |
| S0592 |
Comprehensive contact lens evaluation |
15 |
12 |
$406.40 |
| 92015 |
Determination of refractive state |
170 |
148 |
$140.00 |
| V2750 |
Anti-reflective coating, per lens |
16 |
16 |
$120.86 |
| 2026F |
|
16 |
14 |
$0.00 |
| 92250 |
|
59 |
42 |
$0.00 |