| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,391 |
1,340 |
$72K |
| V2020 |
Frames, purchases |
2,442 |
2,345 |
$48K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
513 |
502 |
$25K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
772 |
741 |
$18K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
281 |
280 |
$8K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
117 |
113 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
343 |
338 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
57 |
57 |
$6K |
| 92015 |
Determination of refractive state |
143 |
138 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
14 |
14 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
29 |
29 |
$719.10 |