| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
222 |
215 |
$18K |
| V2020 |
Frames, purchases |
162 |
156 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
82 |
81 |
$8K |
| 92015 |
Determination of refractive state |
323 |
316 |
$5K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
125 |
118 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$545.40 |