| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
479 |
478 |
$35K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
492 |
492 |
$26K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
163 |
162 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
55 |
55 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
25 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
13 |
12 |
$801.71 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
24 |
$372.00 |
| V2760 |
Scratch resistant coating, per lens |
14 |
14 |
$157.00 |
| 92015 |
Determination of refractive state |
62 |
62 |
$0.00 |