| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
533 |
526 |
$26K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
308 |
296 |
$23K |
| V2020 |
Frames, purchases |
681 |
646 |
$20K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
663 |
629 |
$15K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
146 |
140 |
$10K |
| 92015 |
Determination of refractive state |
798 |
762 |
$7K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
88 |
82 |
$4K |
| V2025 |
Deluxe frame |
12 |
12 |
$554.57 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
30 |
29 |
$13.00 |