| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
77 |
77 |
$3K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
92 |
91 |
$3K |
| V2020 |
Frames, purchases |
125 |
125 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
55 |
55 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
92 |
91 |
$374.13 |
| V2025 |
Deluxe frame |
12 |
12 |
$288.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15 |
15 |
$156.00 |
| 92015 |
Determination of refractive state |
183 |
182 |
$118.84 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
24 |
24 |
$33.75 |