| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,297 |
1,048 |
$43K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
997 |
849 |
$35K |
| V2750 |
Anti-reflective coating, per lens |
831 |
682 |
$22K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
263 |
258 |
$21K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
214 |
205 |
$19K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
991 |
817 |
$18K |
| V2020 |
Frames, purchases |
1,110 |
908 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
724 |
586 |
$10K |
| 92015 |
Determination of refractive state |
424 |
410 |
$5K |
| V2025 |
Deluxe frame |
143 |
139 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
107 |
78 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
51 |
51 |
$809.60 |