| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
528 |
523 |
$26K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
202 |
201 |
$8K |
| V2020 |
Frames, purchases |
643 |
638 |
$585.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
548 |
543 |
$174.16 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
407 |
403 |
$88.00 |
| 92015 |
Determination of refractive state |
194 |
194 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
50 |
50 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
41 |
41 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
18 |
18 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
70 |
70 |
$0.00 |