| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
170 |
162 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
151 |
139 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
111 |
105 |
$7K |
| 92015 |
Determination of refractive state |
644 |
549 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
18 |
12 |
$550.11 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
16 |
16 |
$160.00 |