| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,252 |
3,183 |
$83K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,335 |
1,290 |
$61K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
418 |
418 |
$29K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
146 |
138 |
$13K |
| 92002 |
|
132 |
130 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
226 |
225 |
$5K |
| 92015 |
Determination of refractive state |
382 |
332 |
$4K |
| V2756 |
Eye glass case |
2,589 |
2,555 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
43 |
43 |
$1K |
| 3072F |
|
142 |
142 |
$0.00 |