| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
181 |
178 |
$7K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
72 |
71 |
$5K |
| V2760 |
Scratch resistant coating, per lens |
173 |
169 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
59 |
55 |
$2K |
| 92015 |
Determination of refractive state |
182 |
180 |
$1K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
51 |
51 |
$480.00 |