| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
122 |
121 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
216 |
207 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
35 |
33 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
64 |
64 |
$0.00 |
| V2020 |
Frames, purchases |
666 |
661 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
433 |
433 |
$0.00 |
| 92015 |
Determination of refractive state |
363 |
363 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
134 |
134 |
$0.00 |