| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
1,143 |
1,108 |
$49K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
331 |
324 |
$28K |
| V2020 |
Frames, purchases |
225 |
225 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
235 |
235 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
58 |
56 |
$5K |
| 92250 |
|
82 |
79 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
58 |
57 |
$3K |
| 92082 |
|
71 |
68 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
198 |
198 |
$1K |
| 92015 |
Determination of refractive state |
43 |
43 |
$0.00 |