| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
204 |
197 |
$9K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
28 |
27 |
$1K |
| 92015 |
Determination of refractive state |
189 |
184 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
39 |
27 |
$881.52 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15 |
15 |
$534.97 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
12 |
12 |
$120.00 |