| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,330 |
1,330 |
$53K |
| V2020 |
Frames, purchases |
1,975 |
1,968 |
$48K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,861 |
1,854 |
$32K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
257 |
256 |
$15K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
143 |
142 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
103 |
103 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
72 |
72 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
66 |
66 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$245.80 |
| 92015 |
Determination of refractive state |
332 |
331 |
$140.00 |