| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
420 |
411 |
$31K |
| V2020 |
Frames, purchases |
52 |
52 |
$4K |
| 92015 |
Determination of refractive state |
206 |
201 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$1K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
25 |
25 |
$672.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$426.90 |