| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
859 |
834 |
$24K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
296 |
295 |
$19K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
299 |
298 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
118 |
115 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
154 |
154 |
$5K |
| 92250 |
|
233 |
233 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
26 |
26 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$555.00 |