| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
2,480 |
2,478 |
$150K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,185 |
4,076 |
$130K |
| V2020 |
Frames, purchases |
4,319 |
4,210 |
$101K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
815 |
814 |
$82K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
559 |
557 |
$68K |
| 92250 |
|
148 |
147 |
$9K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
114 |
101 |
$8K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
84 |
84 |
$5K |
| 92060 |
|
70 |
70 |
$4K |
| 92015 |
Determination of refractive state |
1,575 |
1,572 |
$900.76 |
| 3072F |
|
17 |
12 |
$90.00 |