| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
616 |
570 |
$24K |
| V2020 |
Frames, purchases |
641 |
601 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
364 |
332 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
99 |
94 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
28 |
27 |
$1K |
| V2025 |
Deluxe frame |
20 |
15 |
$656.29 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
12 |
$156.59 |
| 92015 |
Determination of refractive state |
15 |
15 |
$80.62 |
| 92250 |
|
25 |
18 |
$39.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
135 |
126 |
$0.00 |