| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,420 |
2,291 |
$101K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
465 |
444 |
$32K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
993 |
682 |
$25K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
165 |
155 |
$15K |
| 92015 |
Determination of refractive state |
1,910 |
1,803 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
124 |
118 |
$5K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
331 |
298 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
40 |
28 |
$877.63 |
| V2760 |
Scratch resistant coating, per lens |
26 |
26 |
$553.52 |