| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
691 |
688 |
$45K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
265 |
251 |
$13K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
73 |
73 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
48 |
48 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
29 |
29 |
$1K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
12 |
12 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
12 |
$317.20 |
| 92015 |
Determination of refractive state |
27 |
27 |
$0.00 |