| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
565 |
565 |
$0.00 |
| V2020 |
Frames, purchases |
1,078 |
1,070 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
35 |
26 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
36 |
18 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
402 |
402 |
$0.00 |
| V2025 |
Deluxe frame |
13 |
13 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
424 |
310 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
596 |
364 |
$0.00 |
| 92004 |
|
81 |
81 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
559 |
333 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
90 |
90 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
26 |
14 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
21 |
15 |
$0.00 |