| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,413 |
1,371 |
$49K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,286 |
1,248 |
$39K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
536 |
519 |
$23K |
| 92015 |
Determination of refractive state |
188 |
188 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
42 |
40 |
$2K |
| 92002 |
|
25 |
25 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$636.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14 |
14 |
$0.00 |
| V2025 |
Deluxe frame |
55 |
55 |
$0.00 |
| 92081 |
|
51 |
51 |
$0.00 |
| 99199 |
Unlisted special service, procedure or report |
15 |
15 |
$0.00 |