| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
204 |
162 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
95 |
80 |
$2K |
| 92015 |
Determination of refractive state |
196 |
163 |
$834.44 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
13 |
$640.83 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
52 |
38 |
$425.54 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$118.00 |