| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
3,044 |
2,817 |
$118K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,691 |
1,599 |
$67K |
| V2020 |
Frames, purchases |
4,550 |
4,117 |
$63K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,160 |
2,871 |
$57K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,094 |
998 |
$19K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
359 |
334 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
742 |
689 |
$8K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
124 |
113 |
$2K |
| V2025 |
Deluxe frame |
36 |
36 |
$893.50 |
| 92015 |
Determination of refractive state |
82 |
81 |
$844.24 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
17 |
12 |
$803.35 |
| V2750 |
Anti-reflective coating, per lens |
28 |
25 |
$188.59 |
| 3072F |
|
62 |
62 |
$0.00 |