| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
207 |
188 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
48 |
48 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
94 |
89 |
$2K |
| 92015 |
Determination of refractive state |
307 |
271 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
16 |
16 |
$815.90 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
52 |
47 |
$482.52 |