| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
577 |
567 |
$312.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
654 |
320 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
216 |
216 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
896 |
440 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
60 |
30 |
$0.00 |
| V2020 |
Frames, purchases |
600 |
593 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
592 |
291 |
$0.00 |