| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
1,574 |
1,530 |
$44K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
459 |
451 |
$12K |
| V2020 |
Frames, purchases |
1,011 |
988 |
$6K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
111 |
111 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
223 |
221 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
405 |
385 |
$960.00 |
| V2760 |
Scratch resistant coating, per lens |
12 |
12 |
$0.00 |
| V2781 |
Progressive lens, per lens |
163 |
162 |
$0.00 |
| 3072F |
|
12 |
12 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
155 |
155 |
$0.00 |
| 2023F |
|
12 |
12 |
$0.00 |