| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
72 |
72 |
$1K |
| 92082 |
|
53 |
53 |
$932.80 |
| V2020 |
Frames, purchases |
146 |
145 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
115 |
115 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
27 |
27 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
29 |
29 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
28 |
28 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
48 |
24 |
$0.00 |