| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
704 |
685 |
$28K |
| V2020 |
Frames, purchases |
1,212 |
1,148 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
652 |
624 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
569 |
548 |
$11K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
26 |
26 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$459.68 |