| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,132 |
968 |
$40K |
| 92015 |
Determination of refractive state |
1,817 |
1,642 |
$25K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
483 |
225 |
$11K |
| V2755 |
U-v lens, per lens |
573 |
388 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
107 |
89 |
$8K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
61 |
57 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$1K |