| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
481 |
455 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
140 |
136 |
$8K |
| 92250 |
|
159 |
156 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
41 |
38 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
77 |
75 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
120 |
103 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
171 |
166 |
$3K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
43 |
41 |
$1K |
| 92015 |
Determination of refractive state |
152 |
145 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
30 |
26 |
$411.80 |