| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
83 |
83 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
73 |
73 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
34 |
17 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
110 |
55 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
26 |
13 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
72 |
36 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
34 |
17 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
19 |
19 |
$0.00 |