| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,400 |
1,342 |
$70K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
725 |
599 |
$28K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
787 |
751 |
$24K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
704 |
691 |
$21K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
265 |
260 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
165 |
145 |
$5K |
| 92002 |
|
101 |
98 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
302 |
212 |
$4K |
| V2025 |
Deluxe frame |
81 |
78 |
$4K |
| 92015 |
Determination of refractive state |
96 |
93 |
$777.35 |