| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
84 |
42 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
130 |
65 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
66 |
66 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
15 |
15 |
$0.00 |
| V2020 |
Frames, purchases |
420 |
419 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
123 |
123 |
$0.00 |