| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
356 |
334 |
$23K |
| V2025 |
Deluxe frame |
163 |
163 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
196 |
171 |
$4K |
| V2020 |
Frames, purchases |
186 |
181 |
$3K |
| 92015 |
Determination of refractive state |
150 |
148 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
143 |
138 |
$2K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
45 |
43 |
$2K |