| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
151 |
123 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
185 |
185 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
493 |
289 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
340 |
180 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
12 |
12 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
831 |
831 |
$0.00 |
| 92015 |
Determination of refractive state |
644 |
643 |
$0.00 |
| V2020 |
Frames, purchases |
562 |
562 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
457 |
269 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
41 |
41 |
$0.00 |