| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
392 |
374 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
182 |
174 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
183 |
174 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
131 |
117 |
$5K |
| 92015 |
Determination of refractive state |
839 |
777 |
$4K |
| V2760 |
Scratch resistant coating, per lens |
233 |
224 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
217 |
215 |
$2K |
| V2755 |
U-v lens, per lens |
13 |
13 |
$0.00 |