| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
98 |
98 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
259 |
259 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
38 |
38 |
$0.00 |
| 92015 |
Determination of refractive state |
401 |
400 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
68 |
68 |
$0.00 |
| V2025 |
Deluxe frame |
363 |
363 |
$0.00 |