| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
931 |
930 |
$39K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
671 |
670 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
387 |
387 |
$10K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
51 |
51 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
73 |
72 |
$443.00 |
| 92002 |
|
12 |
12 |
$375.00 |
| 92250 |
|
12 |
12 |
$152.00 |
| V2750 |
Anti-reflective coating, per lens |
13 |
12 |
$36.00 |
| 92015 |
Determination of refractive state |
1,120 |
1,119 |
$0.00 |