| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
843 |
834 |
$35K |
| V2025 |
Deluxe frame |
397 |
388 |
$19K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
699 |
663 |
$16K |
| V2020 |
Frames, purchases |
709 |
663 |
$11K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
247 |
240 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
69 |
68 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
107 |
94 |
$2K |
| 92015 |
Determination of refractive state |
184 |
174 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
31 |
28 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
40 |
39 |
$974.26 |