| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
1,375 |
1,286 |
$41K |
| V2020 |
Frames, purchases |
87 |
79 |
$6K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
192 |
186 |
$6K |
| 92310 |
|
82 |
54 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
15 |
13 |
$338.60 |
| 92250 |
|
53 |
27 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
37 |
29 |
$0.00 |
| 92015 |
Determination of refractive state |
301 |
226 |
$0.00 |