| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
428 |
420 |
$15K |
| V2760 |
Scratch resistant coating, per lens |
327 |
321 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
102 |
95 |
$4K |
| 92015 |
Determination of refractive state |
419 |
365 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
43 |
41 |
$1K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
63 |
61 |
$520.00 |