| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
399 |
384 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
315 |
300 |
$13K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
92 |
92 |
$8K |
| 92015 |
Determination of refractive state |
543 |
496 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
386 |
200 |
$968.31 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
314 |
306 |
$442.50 |
| V2755 |
U-v lens, per lens |
15 |
15 |
$0.00 |