| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
553 |
533 |
$36K |
| V2020 |
Frames, purchases |
652 |
634 |
$28K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
265 |
255 |
$11K |
| 92015 |
Determination of refractive state |
1,152 |
1,106 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
25 |
25 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
185 |
180 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
26 |
26 |
$468.70 |