| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,379 |
1,362 |
$59K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,024 |
1,017 |
$43K |
| V2020 |
Frames, purchases |
2,252 |
2,169 |
$37K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,077 |
1,039 |
$20K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
785 |
753 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
30 |
27 |
$480.12 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
18 |
14 |
$294.08 |
| 92015 |
Determination of refractive state |
57 |
57 |
$15.50 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
25 |
25 |
$0.00 |