| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99213 |
|
24 |
24 |
$960.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
147 |
85 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
174 |
103 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
33 |
33 |
$0.00 |
| 92004 |
|
53 |
53 |
$0.00 |
| 92014 |
|
388 |
388 |
$0.00 |
| V2020 |
Frames, purchases |
530 |
529 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
143 |
143 |
$0.00 |