| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
676 |
662 |
$43K |
| V2020 |
Frames, purchases |
1,550 |
1,504 |
$39K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
329 |
326 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,135 |
1,104 |
$16K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
690 |
677 |
$15K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
169 |
163 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
607 |
597 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
87 |
82 |
$6K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
392 |
382 |
$5K |
| V2750 |
Anti-reflective coating, per lens |
205 |
203 |
$5K |
| 92015 |
Determination of refractive state |
388 |
367 |
$394.52 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
13 |
13 |
$341.71 |