| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,262 |
1,216 |
$79K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
452 |
430 |
$37K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
1,149 |
1,109 |
$33K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,288 |
658 |
$28K |
| 92015 |
Determination of refractive state |
1,063 |
1,022 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
96 |
96 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
41 |
15 |
$473.34 |