| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
694 |
340 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
948 |
473 |
$0.00 |
| 92004 |
|
137 |
137 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
162 |
80 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
94 |
46 |
$0.00 |
| G8397 |
Dilated macular or fundus exam performed, including documentation of the presence or absence of macular edema and level of severity of retinopathy |
28 |
28 |
$0.00 |
| V2781 |
Progressive lens, per lens |
58 |
29 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
58 |
29 |
$0.00 |
| 92014 |
|
806 |
801 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
216 |
108 |
$0.00 |
| V2020 |
Frames, purchases |
681 |
672 |
$0.00 |
| 92015 |
|
1,011 |
1,003 |
$0.00 |