| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
446 |
439 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
310 |
154 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
373 |
368 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
421 |
236 |
$0.00 |
| 92002 |
|
17 |
17 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
19 |
12 |
$0.00 |
| 92250 |
|
52 |
52 |
$0.00 |