| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
175 |
156 |
$7K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
183 |
142 |
$7K |
| V2020 |
Frames, purchases |
261 |
242 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
365 |
192 |
$3K |
| 92015 |
Determination of refractive state |
423 |
354 |
$289.14 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
16 |
16 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$0.00 |