| 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 |
208 |
100 |
$0.00 |
| V2756 |
Eye glass case |
165 |
159 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
90 |
90 |
$0.00 |
| 92342 |
|
165 |
159 |
$0.00 |
| 2022F |
|
196 |
196 |
$0.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
147 |
142 |
$0.00 |
| 92015 |
Determination of refractive state |
204 |
204 |
$0.00 |
| G0117 |
Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist |
206 |
206 |
$0.00 |
| V2020 |
Frames, purchases |
157 |
150 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
58 |
58 |
$0.00 |