| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
5,733 |
5,497 |
$236K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
3,806 |
3,680 |
$158K |
| V2020 |
Frames, purchases |
3,421 |
3,278 |
$58K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,283 |
2,180 |
$46K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
704 |
693 |
$8K |
| V2025 |
Deluxe frame |
299 |
295 |
$8K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
352 |
340 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
86 |
85 |
$3K |
| 92015 |
Determination of refractive state |
255 |
253 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
54 |
52 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$285.42 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$249.12 |
| 2023F |
|
447 |
409 |
$50.00 |