| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
805 |
805 |
$950.98 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
167 |
166 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
55 |
55 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
62 |
62 |
$0.00 |
| V2781 |
Progressive lens, per lens |
64 |
64 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
116 |
116 |
$0.00 |
| 92015 |
Determination of refractive state |
918 |
918 |
$0.00 |
| V2020 |
Frames, purchases |
1,304 |
1,302 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
199 |
199 |
$0.00 |