| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
330 |
328 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
356 |
224 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
109 |
95 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
436 |
285 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
339 |
337 |
$0.00 |
| V2020 |
Frames, purchases |
874 |
859 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
16 |
16 |
$0.00 |