| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
557 |
550 |
$4K |
| 92250 |
|
13 |
12 |
$166.95 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
290 |
289 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
107 |
107 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
65 |
65 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
402 |
398 |
$0.00 |