| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
236 |
234 |
$9K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
54 |
47 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$1K |
| 92015 |
Determination of refractive state |
351 |
337 |
$1K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
37 |
37 |
$360.00 |
| V2760 |
Scratch resistant coating, per lens |
25 |
24 |
$262.00 |