| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
793 |
692 |
$30K |
| 92015 |
Determination of refractive state |
1,214 |
1,060 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
223 |
212 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
225 |
96 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
66 |
51 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
107 |
57 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
42 |
38 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$1K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
104 |
90 |
$860.00 |
| V2756 |
Eye glass case |
246 |
195 |
$237.53 |