| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
6,012 |
5,750 |
$248K |
| V2025 |
Deluxe frame |
3,888 |
3,835 |
$217K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,044 |
4,807 |
$105K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
2,140 |
2,092 |
$90K |
| V2020 |
Frames, purchases |
5,406 |
5,040 |
$87K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,051 |
1,972 |
$46K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,692 |
1,609 |
$32K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
144 |
142 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
342 |
312 |
$5K |
| 92015 |
Determination of refractive state |
203 |
194 |
$3K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
57 |
51 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
27 |
25 |
$1K |