| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
7,122 |
6,017 |
$240K |
| V2020 |
Frames, purchases |
14,907 |
13,074 |
$192K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
4,836 |
4,248 |
$172K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
7,687 |
6,521 |
$101K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,683 |
3,275 |
$48K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,955 |
3,649 |
$42K |
| V2025 |
Deluxe frame |
122 |
112 |
$3K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
90 |
87 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
168 |
153 |
$820.86 |
| 92015 |
Determination of refractive state |
232 |
186 |
$125.50 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,493 |
709 |
$0.00 |