| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,587 |
1,556 |
$75K |
| V2020 |
Frames, purchases |
1,643 |
1,592 |
$60K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
719 |
701 |
$25K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
270 |
261 |
$19K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
947 |
925 |
$17K |
| 92015 |
Determination of refractive state |
2,331 |
2,220 |
$9K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
166 |
163 |
$6K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
141 |
141 |
$965.00 |
| 92250 |
|
108 |
101 |
$780.00 |