| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
969 |
941 |
$41K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
761 |
721 |
$33K |
| 92015 |
Determination of refractive state |
1,476 |
1,380 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
107 |
105 |
$4K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
147 |
143 |
$1K |
| 92002 |
|
12 |
12 |
$659.52 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$448.96 |