| 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 |
124 |
124 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
154 |
154 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
17 |
17 |
$0.00 |
| 92015 |
Determination of refractive state |
200 |
199 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
81 |
81 |
$0.00 |
| V2020 |
Frames, purchases |
129 |
129 |
$0.00 |