| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
351 |
341 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
183 |
176 |
$7K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
121 |
116 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
39 |
39 |
$3K |
| 92015 |
Determination of refractive state |
387 |
360 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
13 |
13 |
$130.00 |