| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,802 |
1,606 |
$54K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,591 |
1,368 |
$48K |
| V2020 |
Frames, purchases |
293 |
269 |
$21K |
| 92310 |
|
350 |
265 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
176 |
161 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
34 |
28 |
$571.10 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
47 |
36 |
$0.00 |
| 92015 |
Determination of refractive state |
487 |
451 |
$0.00 |
| 92250 |
|
1,135 |
713 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
13 |
13 |
$0.00 |