| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,066 |
960 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,144 |
524 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
18 |
18 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
13 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
24 |
12 |
$0.00 |
| V2020 |
Frames, purchases |
1,213 |
1,133 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,873 |
1,871 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
446 |
203 |
$0.00 |
| 92015 |
Determination of refractive state |
118 |
118 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
204 |
90 |
$0.00 |