| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
89 |
54 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
304 |
171 |
$0.00 |
| 92004 |
|
153 |
153 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
77 |
77 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
83 |
59 |
$0.00 |
| V2020 |
Frames, purchases |
345 |
343 |
$0.00 |
| 92014 |
|
186 |
186 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
73 |
73 |
$0.00 |