| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92060 |
|
339 |
332 |
$17K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
81 |
78 |
$5K |
| 92015 |
Determination of refractive state |
173 |
169 |
$3K |
| V2020 |
Frames, purchases |
77 |
76 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
19 |
17 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
24 |
24 |
$750.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
54 |
53 |
$197.00 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
12 |
12 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$0.00 |