| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
150 |
124 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
160 |
137 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
192 |
169 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
18 |
15 |
$0.00 |
| V2020 |
Frames, purchases |
419 |
344 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
298 |
254 |
$0.00 |
| 92015 |
Determination of refractive state |
663 |
603 |
$0.00 |