| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,362 |
1,977 |
$76K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
708 |
679 |
$28K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
266 |
266 |
$9K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
27 |
27 |
$660.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
455 |
441 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
84 |
84 |
$0.00 |
| 92002 |
|
12 |
12 |
$0.00 |
| V2020 |
Frames, purchases |
996 |
937 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
14 |
$0.00 |