| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
791 |
718 |
$32K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
238 |
215 |
$14K |
| 92015 |
Determination of refractive state |
1,254 |
1,119 |
$6K |
| 92250 |
|
152 |
140 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
67 |
66 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
114 |
104 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
42 |
40 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
151 |
142 |
$1K |
| V2025 |
Deluxe frame |
60 |
58 |
$0.00 |