| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
25 |
25 |
$1K |
| 92014 |
|
3,533 |
3,524 |
$182.00 |
| 92004 |
|
1,228 |
1,227 |
$78.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,621 |
2,265 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,281 |
2,619 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
993 |
516 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
130 |
63 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
32 |
32 |
$0.00 |
| V2599 |
Contact lens, other type |
25 |
25 |
$0.00 |
| V2020 |
Frames, purchases |
4,191 |
4,102 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
366 |
179 |
$0.00 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
24 |
24 |
$0.00 |
| 92015 |
|
117 |
117 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
51 |
26 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
59 |
59 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
56 |
28 |
$0.00 |