| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
87 |
72 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
327 |
215 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
12 |
12 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
73 |
40 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
354 |
354 |
$0.00 |
| V2020 |
Frames, purchases |
387 |
386 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
30 |
30 |
$0.00 |
| 92015 |
Determination of refractive state |
63 |
63 |
$0.00 |