| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
890 |
863 |
$79K |
| V2020 |
Frames, purchases |
787 |
736 |
$19K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
235 |
229 |
$13K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
196 |
189 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
296 |
275 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
15 |
14 |
$651.98 |
| V2756 |
Eye glass case |
583 |
560 |
$584.28 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$191.40 |