| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
655 |
654 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
984 |
984 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
80 |
80 |
$0.00 |
| 92015 |
Determination of refractive state |
46 |
44 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
71 |
71 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
294 |
183 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
186 |
177 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
206 |
115 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
31 |
31 |
$0.00 |