| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,897 |
1,790 |
$78K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
961 |
518 |
$21K |
| 92370 |
|
1,869 |
1,760 |
$12K |
| 92015 |
Determination of refractive state |
2,221 |
2,024 |
$12K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
1,232 |
1,165 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
132 |
116 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
120 |
111 |
$7K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
114 |
110 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
21 |
12 |
$653.98 |