| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
530 |
528 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
662 |
638 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
245 |
229 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
564 |
547 |
$0.00 |
| 92002 |
|
31 |
31 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
27 |
26 |
$0.00 |
| 92310 |
|
12 |
12 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,005 |
1,977 |
$0.00 |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,442 |
1,404 |
$0.00 |
| 92015 |
Determination of refractive state |
3,838 |
3,741 |
$0.00 |
| V2020 |
Frames, purchases |
1,430 |
1,371 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
382 |
358 |
$0.00 |