| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
372 |
368 |
$27K |
| V2020 |
Frames, purchases |
221 |
221 |
$12K |
| 92015 |
Determination of refractive state |
360 |
351 |
$9K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
162 |
162 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
38 |
38 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$663.08 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$392.20 |