| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,211 |
2,971 |
$103K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,284 |
1,199 |
$75K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,151 |
1,025 |
$31K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
240 |
226 |
$20K |
| 92015 |
Determination of refractive state |
3,469 |
3,250 |
$19K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
931 |
886 |
$8K |
| 92250 |
|
74 |
63 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
28 |
24 |
$755.17 |
| 92081 |
|
41 |
32 |
$588.02 |