| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
1,877 |
1,863 |
$8.80 |
| V2020 |
Frames, purchases |
867 |
864 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
856 |
853 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
24 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
576 |
575 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
209 |
206 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
133 |
133 |
$0.00 |