| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
242 |
220 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
83 |
78 |
$5K |
| 92015 |
Determination of refractive state |
327 |
309 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
29 |
26 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
15 |
$656.10 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
25 |
25 |
$250.00 |