| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
288 |
278 |
$11K |
| V2760 |
Scratch resistant coating, per lens |
209 |
201 |
$3K |
| 92015 |
Determination of refractive state |
311 |
277 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
17 |
15 |
$891.12 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
24 |
$842.88 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
12 |
12 |
$120.00 |
| 1036F |
|
33 |
29 |
$0.00 |