| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
513 |
501 |
$18K |
| V2020 |
Frames, purchases |
272 |
261 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
103 |
101 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
119 |
114 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
53 |
49 |
$1K |
| 92250 |
|
25 |
25 |
$985.75 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$835.44 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
13 |
$491.40 |