| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
376 |
357 |
$21K |
| V2020 |
Frames, purchases |
692 |
634 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
368 |
339 |
$9K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
63 |
56 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
111 |
109 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$361.20 |
| 92015 |
Determination of refractive state |
13 |
13 |
$199.08 |