| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
673 |
632 |
$27K |
| V2020 |
Frames, purchases |
1,325 |
1,258 |
$27K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
580 |
556 |
$9K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
196 |
152 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
678 |
618 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
387 |
329 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
149 |
135 |
$4K |
| S0500 |
Disposable contact lens, per lens |
12 |
12 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$630.96 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
32 |
27 |
$0.00 |
| 92083 |
|
15 |
13 |
$0.00 |
| 92015 |
Determination of refractive state |
18 |
18 |
$0.00 |