| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,417 |
2,380 |
$2K |
| V2020 |
Frames, purchases |
1,494 |
1,460 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
850 |
422 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,476 |
712 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,191 |
1,082 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
49 |
49 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
50 |
24 |
$0.00 |