| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
543 |
535 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
169 |
168 |
$12K |
| 92250 |
|
233 |
231 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
158 |
153 |
$9K |
| 92285 |
|
427 |
422 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
444 |
435 |
$6K |
| 92015 |
Determination of refractive state |
383 |
379 |
$5K |
| V2219 |
Bifocal seg width over 28 mm |
18 |
17 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
125 |
124 |
$1K |
| 92341 |
|
58 |
55 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
27 |
27 |
$648.00 |
| 92060 |
|
14 |
14 |
$524.16 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$241.50 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
13 |
13 |
$234.00 |