| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
545 |
545 |
$22K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
380 |
380 |
$15K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
264 |
202 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
230 |
221 |
$9K |
| 92015 |
Determination of refractive state |
815 |
815 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
559 |
559 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
71 |
71 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
92 |
92 |
$1K |
| V2025 |
Deluxe frame |
50 |
50 |
$486.00 |