| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
469 |
398 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
416 |
353 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
121 |
100 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
119 |
90 |
$5K |
| 92015 |
Determination of refractive state |
446 |
367 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
117 |
95 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
67 |
56 |
$582.01 |