| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
394 |
377 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
263 |
253 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
382 |
365 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
147 |
139 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
12 |
$358.43 |
| 92015 |
Determination of refractive state |
230 |
211 |
$0.00 |