| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
293 |
265 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
107 |
95 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
93 |
78 |
$4K |
| 92015 |
Determination of refractive state |
497 |
442 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
145 |
125 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
28 |
$379.88 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
29 |
27 |
$272.58 |