| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
482 |
464 |
$34K |
| V2020 |
Frames, purchases |
357 |
347 |
$23K |
| 92015 |
Determination of refractive state |
732 |
708 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
38 |
36 |
$3K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
152 |
148 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
26 |
$593.75 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
12 |
12 |
$190.32 |