| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,677 |
1,667 |
$73K |
| V2020 |
Frames, purchases |
2,818 |
2,803 |
$68K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,483 |
1,470 |
$68K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,353 |
3,338 |
$62K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,853 |
1,802 |
$23K |
| 92341 |
|
270 |
268 |
$6K |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
801 |
792 |
$4K |
| 92015 |
Determination of refractive state |
725 |
722 |
$894.81 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
23 |
23 |
$496.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
15 |
15 |
$284.98 |
| V2756 |
Eye glass case |
766 |
756 |
$139.54 |
| 3072F |
|
308 |
303 |
$0.00 |
| V2755 |
U-v lens, per lens |
299 |
298 |
$0.00 |