| 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 |
423 |
235 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
510 |
284 |
$0.00 |
| 92004 |
|
138 |
138 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
130 |
69 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
20 |
20 |
$0.00 |
| 92014 |
|
540 |
540 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
93 |
93 |
$0.00 |
| V2020 |
Frames, purchases |
523 |
523 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
90 |
45 |
$0.00 |