| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
908 |
884 |
$38K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
305 |
290 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
197 |
186 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
73 |
72 |
$7K |
| 92015 |
Determination of refractive state |
1,087 |
1,045 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
43 |
42 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
219 |
205 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$617.52 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15 |
15 |
$560.00 |
| 3072F |
|
84 |
83 |
$0.00 |