| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,743 |
1,622 |
$67K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
684 |
629 |
$27K |
| V2020 |
Frames, purchases |
2,063 |
1,856 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,214 |
1,080 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
729 |
681 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,053 |
1,004 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
44 |
38 |
$1K |
| 92015 |
Determination of refractive state |
48 |
47 |
$641.60 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
33 |
33 |
$591.66 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
14 |
$475.38 |
| V2025 |
Deluxe frame |
12 |
12 |
$312.44 |