| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,942 |
968 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,050 |
1,022 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
570 |
570 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
300 |
149 |
$0.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
801 |
800 |
$0.00 |
| V2020 |
Frames, purchases |
1,151 |
1,146 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
480 |
238 |
$0.00 |