| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
693 |
693 |
$55K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
800 |
800 |
$44K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
684 |
684 |
$35K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
531 |
531 |
$33K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
60 |
60 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
74 |
74 |
$473.00 |
| V2760 |
Scratch resistant coating, per lens |
14 |
14 |
$117.00 |
| 92015 |
Determination of refractive state |
261 |
257 |
$0.00 |