| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
480 |
460 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
182 |
176 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
486 |
449 |
$6K |
| 92015 |
Determination of refractive state |
582 |
568 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
251 |
241 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
41 |
38 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
38 |
38 |
$1K |
| 92002 |
|
23 |
23 |
$717.90 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
15 |
13 |
$165.00 |