| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
433 |
431 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
424 |
424 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
76 |
76 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
131 |
77 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
28 |
14 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
294 |
174 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
34 |
34 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
109 |
109 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
382 |
219 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
24 |
12 |
$0.00 |