| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
23 |
22 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
53 |
32 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
26 |
12 |
$0.00 |
| 92250 |
|
13 |
13 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
282 |
160 |
$0.00 |
| 92015 |
Determination of refractive state |
366 |
208 |
$0.00 |
| V2020 |
Frames, purchases |
215 |
109 |
$0.00 |