| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
988 |
985 |
$17K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
243 |
243 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
337 |
336 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
497 |
496 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
94 |
94 |
$4K |
| V2755 |
U-v lens, per lens |
12 |
12 |
$0.00 |
| 92015 |
Determination of refractive state |
688 |
678 |
$0.00 |