| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
264 |
220 |
$16K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
105 |
92 |
$8K |
| 92015 |
Determination of refractive state |
494 |
434 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
42 |
38 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
132 |
67 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
48 |
39 |
$4K |