| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,061 |
1,021 |
$41K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
130 |
127 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
163 |
153 |
$8K |
| 92015 |
Determination of refractive state |
1,349 |
1,260 |
$8K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
115 |
110 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
94 |
83 |
$3K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
181 |
178 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
13 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
16 |
16 |
$682.79 |
| 3072F |
|
13 |
13 |
$0.00 |