| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,507 |
1,341 |
$64K |
| V2760 |
Scratch resistant coating, per lens |
1,427 |
1,266 |
$26K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
655 |
560 |
$24K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
158 |
151 |
$9K |
| 92015 |
Determination of refractive state |
1,210 |
1,152 |
$7K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
612 |
530 |
$6K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
96 |
87 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
40 |
40 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
18 |
18 |
$838.68 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
13 |
$467.91 |