| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
251 |
251 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
45 |
45 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
270 |
270 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
44 |
25 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
47 |
32 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
60 |
60 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
98 |
53 |
$0.00 |