| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
260 |
216 |
$15K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
160 |
143 |
$12K |
| V2020 |
Frames, purchases |
585 |
514 |
$9K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
303 |
259 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
24 |
24 |
$2K |
| 92015 |
Determination of refractive state |
132 |
125 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
74 |
67 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
70 |
70 |
$1K |
| V2799 |
Vision item or service, miscellaneous |
33 |
31 |
$431.04 |
| 2026F |
|
15 |
15 |
$0.00 |