| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
302 |
294 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
72 |
72 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
172 |
172 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
87 |
68 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
14 |
13 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
13 |
$0.00 |