| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
298 |
268 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
29 |
27 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
53 |
51 |
$2K |
| 92015 |
Determination of refractive state |
216 |
185 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
16 |
13 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
70 |
63 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
48 |
46 |
$924.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
19 |
13 |
$198.00 |