| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
249 |
244 |
$43.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
224 |
139 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
70 |
54 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
31 |
30 |
$0.00 |
| V2020 |
Frames, purchases |
297 |
292 |
$0.00 |
| 92015 |
Determination of refractive state |
44 |
42 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
17 |
17 |
$0.00 |