| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
3,612 |
3,600 |
$160K |
| V2025 |
Deluxe frame |
2,120 |
2,117 |
$143K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,177 |
2,171 |
$97K |
| V2020 |
Frames, purchases |
3,256 |
3,218 |
$59K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,904 |
2,876 |
$51K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,098 |
1,081 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
535 |
527 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
126 |
125 |
$4K |
| 92310 |
|
28 |
28 |
$2K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
28 |
28 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
83 |
78 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
51 |
51 |
$802.77 |
| 92015 |
Determination of refractive state |
46 |
46 |
$679.86 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
14 |
14 |
$312.31 |