| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
565 |
559 |
$38K |
| V2020 |
Frames, purchases |
638 |
633 |
$21K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
266 |
265 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
305 |
303 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
97 |
97 |
$578.00 |
| 92015 |
Determination of refractive state |
220 |
220 |
$456.00 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
14 |
14 |
$282.60 |