| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,395 |
3,272 |
$143K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,381 |
1,337 |
$86K |
| V2760 |
Scratch resistant coating, per lens |
5,458 |
3,360 |
$63K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,191 |
1,410 |
$59K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
549 |
537 |
$50K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
2,563 |
1,551 |
$15K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
31 |
30 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
19 |
13 |
$508.44 |
| 92015 |
Determination of refractive state |
31 |
30 |
$182.70 |