| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
218 |
123 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
42 |
42 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
395 |
218 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
87 |
87 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
126 |
126 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
474 |
259 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
371 |
371 |
$0.00 |
| V2020 |
Frames, purchases |
496 |
489 |
$0.00 |