| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
373 |
366 |
$23K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
159 |
155 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
81 |
76 |
$4K |
| 92015 |
Determination of refractive state |
521 |
480 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
170 |
165 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
71 |
52 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
58 |
50 |
$16.55 |
| V2025 |
Deluxe frame |
57 |
57 |
$0.00 |