| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
971 |
870 |
$37K |
| V2020 |
Frames, purchases |
1,296 |
1,161 |
$17K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
317 |
296 |
$13K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
723 |
641 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
145 |
117 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
113 |
93 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
28 |
28 |
$840.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
45 |
42 |
$820.27 |
| 92015 |
Determination of refractive state |
88 |
55 |
$192.84 |
| 2023F |
|
15 |
14 |
$0.00 |
| 2033F |
|
14 |
13 |
$0.00 |