| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
175 |
169 |
$7K |
| 92015 |
Determination of refractive state |
591 |
564 |
$3K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
54 |
52 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
13 |
$668.34 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16 |
12 |
$336.87 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
16 |
14 |
$140.00 |