| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,311 |
2,272 |
$119K |
| V2020 |
Frames, purchases |
3,979 |
3,795 |
$115K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,908 |
1,874 |
$93K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,426 |
2,326 |
$50K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
286 |
279 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
195 |
185 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
30 |
30 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
42 |
41 |
$2K |
| 92015 |
Determination of refractive state |
134 |
130 |
$400.70 |
| V2025 |
Deluxe frame |
24 |
23 |
$357.00 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
12 |
12 |
$294.48 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
112 |
108 |
$84.50 |