| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,411 |
1,348 |
$95K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,714 |
1,647 |
$51K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,196 |
1,160 |
$36K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
973 |
933 |
$29K |
| 92310 |
|
151 |
137 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
29 |
29 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
26 |
26 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
26 |
25 |
$804.34 |
| 92015 |
Determination of refractive state |
129 |
129 |
$499.50 |