| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
323 |
291 |
$13K |
| 92015 |
Determination of refractive state |
908 |
762 |
$4K |
| V2760 |
Scratch resistant coating, per lens |
320 |
288 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
107 |
53 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
13 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$917.88 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
30 |
24 |
$893.15 |