| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
688 |
677 |
$30K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
364 |
360 |
$15K |
| V2025 |
Deluxe frame |
334 |
331 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
535 |
511 |
$14K |
| V2020 |
Frames, purchases |
745 |
705 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
203 |
196 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
87 |
84 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$1K |
| 92015 |
Determination of refractive state |
47 |
47 |
$644.18 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
19 |
19 |
$332.34 |