| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,767 |
1,748 |
$158K |
| V2020 |
Frames, purchases |
2,183 |
2,127 |
$55K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
404 |
401 |
$30K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
664 |
646 |
$15K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
116 |
116 |
$7K |
| 92002 |
|
72 |
72 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
30 |
29 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
86 |
85 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
17 |
15 |
$860.84 |
| V2756 |
Eye glass case |
732 |
720 |
$767.88 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16 |
14 |
$443.28 |
| 92133 |
|
15 |
14 |
$352.24 |
| 92015 |
Determination of refractive state |
38 |
37 |
$0.00 |
| G8422 |
Bmi not documented, documentation the patient is not eligible for bmi calculation |
13 |
12 |
$0.00 |