| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
323 |
303 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
128 |
122 |
$11K |
| V2760 |
Scratch resistant coating, per lens |
273 |
261 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
109 |
105 |
$4K |
| 92002 |
|
71 |
68 |
$4K |
| 92015 |
Determination of refractive state |
487 |
436 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
96 |
96 |
$870.00 |
| 92370 |
|
91 |
87 |
$556.92 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
15 |
13 |
$107.12 |