| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
Determination of refractive state |
139 |
139 |
$0.00 |
| V2020 |
Frames, purchases |
43 |
43 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
50 |
50 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
66 |
65 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
94 |
93 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
12 |
12 |
$0.00 |