| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
132 |
132 |
$222.70 |
| V2020 |
Frames, purchases |
154 |
154 |
$0.00 |
| 92015 |
Determination of refractive state |
171 |
171 |
$0.00 |
| V2025 |
Deluxe frame |
15 |
15 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
109 |
109 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
123 |
123 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$0.00 |