| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
641 |
614 |
$19K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
263 |
261 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
361 |
350 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
489 |
481 |
$5K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
81 |
80 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13 |
13 |
$465.84 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
13 |
$213.38 |
| 92015 |
Determination of refractive state |
12 |
12 |
$131.78 |