| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,006 |
959 |
$18K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
321 |
169 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
163 |
143 |
$7K |
| 92015 |
Determination of refractive state |
1,196 |
1,135 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
380 |
172 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
31 |
30 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
126 |
51 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
27 |
17 |
$729.04 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
51 |
27 |
$548.18 |