| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
228 |
228 |
$23K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
249 |
177 |
$13K |
| V2020 |
Frames, purchases |
245 |
244 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
64 |
64 |
$8K |
| 92015 |
Determination of refractive state |
70 |
70 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$439.92 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
16 |
16 |
$160.00 |