| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
74 |
74 |
$3K |
| V2020 |
Frames, purchases |
116 |
116 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
24 |
24 |
$969.50 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
70 |
55 |
$716.22 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
58 |
37 |
$217.98 |
| 92015 |
Determination of refractive state |
20 |
13 |
$0.00 |