| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,247 |
1,242 |
$60K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,255 |
1,241 |
$26K |
| V2020 |
Frames, purchases |
503 |
501 |
$16K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
273 |
262 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
101 |
100 |
$2K |
| 92342 |
|
38 |
38 |
$986.26 |
| 92015 |
Determination of refractive state |
147 |
147 |
$388.15 |
| V2715 |
Prism, per lens |
12 |
12 |
$58.65 |
| V2756 |
Eye glass case |
25 |
25 |
$6.75 |