| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
198 |
192 |
$9K |
| V2020 |
Frames, purchases |
268 |
262 |
$9K |
| 92015 |
Determination of refractive state |
341 |
327 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
38 |
38 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
23 |
$638.28 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
58 |
53 |
$487.50 |