| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
698 |
657 |
$23K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
309 |
299 |
$21K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
232 |
219 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
575 |
543 |
$20K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
258 |
245 |
$12K |
| 92015 |
Determination of refractive state |
854 |
820 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
24 |
24 |
$1K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
14 |
14 |
$939.96 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$650.00 |