| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
484 |
433 |
$20K |
| V2020 |
Frames, purchases |
340 |
326 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
51 |
50 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
105 |
102 |
$3K |
| 92015 |
Determination of refractive state |
611 |
565 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
27 |
27 |
$1K |
| V2760 |
Scratch resistant coating, per lens |
128 |
119 |
$972.00 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
75 |
74 |
$725.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$720.00 |