| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
214 |
214 |
$688.00 |
| V2020 |
Frames, purchases |
127 |
127 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
49 |
49 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
106 |
65 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
93 |
56 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
12 |
$0.00 |