| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
812 |
775 |
$34K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
184 |
174 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
93 |
88 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
288 |
150 |
$7K |
| 92015 |
Determination of refractive state |
841 |
796 |
$5K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
351 |
335 |
$3K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
38 |
17 |
$780.60 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
13 |
$745.92 |
| 92250 |
|
14 |
14 |
$624.00 |