| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
452 |
419 |
$31K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
312 |
293 |
$22K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
343 |
321 |
$19K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
128 |
126 |
$10K |
| 92015 |
Determination of refractive state |
933 |
820 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
25 |
$1K |
| 92250 |
|
46 |
41 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
41 |
37 |
$712.36 |