| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
184 |
165 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
56 |
53 |
$3K |
| 92015 |
Determination of refractive state |
244 |
228 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
48 |
30 |
$851.04 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
162 |
76 |
$730.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
19 |
12 |
$306.15 |