| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,208 |
822 |
$38K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
595 |
292 |
$15K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
102 |
89 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
78 |
77 |
$3K |
| V2025 |
Deluxe frame |
43 |
43 |
$2K |
| 92002 |
|
46 |
44 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
23 |
23 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15 |
15 |
$112.00 |
| 92015 |
Determination of refractive state |
206 |
205 |
$35.00 |