| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
980 |
778 |
$0.00 |
| 92015 |
Determination of refractive state |
1,090 |
1,011 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
763 |
621 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
35 |
25 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
418 |
327 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
650 |
526 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
445 |
351 |
$0.00 |