| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
651 |
645 |
$11K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
86 |
85 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
167 |
163 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
28 |
28 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
88 |
85 |
$562.50 |
| V2755 |
U-v lens, per lens |
112 |
112 |
$0.00 |
| 92015 |
Determination of refractive state |
366 |
360 |
$0.00 |