| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,620 |
1,611 |
$82K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,000 |
1,835 |
$42K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
868 |
863 |
$42K |
| V2020 |
Frames, purchases |
1,765 |
1,624 |
$28K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
125 |
96 |
$8K |
| V2025 |
Deluxe frame |
348 |
338 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
52 |
42 |
$4K |
| 92015 |
Determination of refractive state |
415 |
311 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
87 |
86 |
$384.00 |