| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
522 |
506 |
$48K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
391 |
360 |
$23K |
| V2020 |
Frames, purchases |
773 |
673 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
144 |
133 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
69 |
66 |
$1K |
| 92015 |
Determination of refractive state |
782 |
774 |
$0.00 |