| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
739 |
731 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
183 |
183 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
276 |
200 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
215 |
215 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
198 |
99 |
$821.60 |
| 92015 |
Determination of refractive state |
12 |
12 |
$31.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
48 |
24 |
$0.00 |