| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
235 |
234 |
$16K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
141 |
141 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
24 |
24 |
$2K |
| 92015 |
Determination of refractive state |
131 |
131 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
61 |
61 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$997.80 |