| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
341 |
341 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
81 |
81 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
80 |
40 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
46 |
23 |
$944.84 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
13 |
13 |
$520.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
614 |
307 |
$0.00 |
| 92015 |
Determination of refractive state |
32 |
32 |
$0.00 |