| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
457 |
456 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
647 |
628 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
542 |
528 |
$8K |
| V2020 |
Frames, purchases |
621 |
605 |
$7K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
91 |
91 |
$3K |
| V2025 |
Deluxe frame |
42 |
37 |
$605.78 |
| 92015 |
Determination of refractive state |
849 |
840 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
14 |
14 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
64 |
62 |
$0.00 |
| S9986 |
Not medically necessary service (patient is aware that service not medically necessary) |
53 |
53 |
$0.00 |
| V2755 |
U-v lens, per lens |
13 |
13 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
46 |
45 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
29 |
29 |
$0.00 |