| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
825 |
746 |
$25K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
183 |
173 |
$10K |
| V2760 |
Scratch resistant coating, per lens |
648 |
596 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
172 |
138 |
$4K |
| 92015 |
Determination of refractive state |
748 |
696 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
108 |
105 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
52 |
52 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
27 |
26 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
14 |
$1K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
115 |
107 |
$858.50 |
| V2755 |
U-v lens, per lens |
62 |
59 |
$168.50 |
| V2756 |
Eye glass case |
12 |
12 |
$0.00 |