| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
587 |
514 |
$13K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
323 |
283 |
$12K |
| V2715 |
Prism, per lens |
1,046 |
558 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
375 |
210 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
46 |
44 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
17 |
17 |
$1K |
| 92015 |
Determination of refractive state |
274 |
236 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
15 |
$983.64 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
51 |
24 |
$331.19 |