| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological examination including refraction; established patient |
931 |
910 |
$45K |
| V2020 |
Frames, purchases |
1,503 |
1,469 |
$32K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
379 |
372 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
606 |
597 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
57 |
56 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
37 |
36 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
12 |
12 |
$278.98 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15 |
15 |
$222.00 |