| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
192 |
95 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
133 |
132 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
210 |
105 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
70 |
35 |
$0.00 |
| V2020 |
Frames, purchases |
278 |
277 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
178 |
178 |
$0.00 |