| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
353 |
350 |
$18K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
320 |
313 |
$16K |
| V2020 |
Frames, purchases |
406 |
404 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
423 |
418 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
44 |
44 |
$4K |
| 92015 |
Determination of refractive state |
194 |
188 |
$993.04 |
| V2750 |
Anti-reflective coating, per lens |
344 |
342 |
$725.65 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
457 |
454 |
$464.00 |