| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
218 |
107 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
859 |
420 |
$0.00 |
| S0592 |
Comprehensive contact lens evaluation |
89 |
89 |
$0.00 |
| V2755 |
U-v lens, per lens |
88 |
43 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
360 |
359 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
70 |
35 |
$0.00 |
| V2020 |
Frames, purchases |
707 |
694 |
$0.00 |
| 92015 |
Determination of refractive state |
477 |
476 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
714 |
713 |
$0.00 |
| V2500 |
Contact lens, pmma, spherical, per lens |
89 |
89 |
$0.00 |