| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
1,440 |
1,429 |
$0.00 |
| V2020 |
Frames, purchases |
1,439 |
1,430 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,313 |
1,306 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
13 |
13 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
55 |
52 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
912 |
899 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
52 |
52 |
$0.00 |