| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
578 |
576 |
$0.00 |
| 92250 |
|
225 |
222 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
803 |
436 |
$0.00 |
| 92002 |
|
24 |
24 |
$0.00 |
| 92310 |
|
52 |
52 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
250 |
245 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
50 |
28 |
$0.00 |
| V2020 |
Frames, purchases |
667 |
662 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
138 |
69 |
$0.00 |