| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,478 |
1,384 |
$57K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
660 |
578 |
$32K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
540 |
375 |
$14K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
195 |
170 |
$14K |
| 92370 |
|
1,548 |
1,437 |
$10K |
| 92015 |
Determination of refractive state |
1,815 |
1,579 |
$9K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
702 |
658 |
$6K |
| 76512 |
|
25 |
12 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
15 |
$775.33 |