| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
24 |
13 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
48 |
24 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
43 |
43 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
111 |
111 |
$0.00 |
| V2020 |
Frames, purchases |
163 |
159 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
14 |
14 |
$0.00 |