| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
4,838 |
4,807 |
$209K |
| V2020 |
Frames, purchases |
5,600 |
5,517 |
$122K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,038 |
3,990 |
$109K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,126 |
2,115 |
$91K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,139 |
2,121 |
$8K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
92 |
92 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
30 |
30 |
$726.60 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
24 |
22 |
$477.48 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$423.75 |