| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,471 |
1,462 |
$74K |
| V2020 |
Frames, purchases |
1,320 |
1,319 |
$71K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,145 |
1,134 |
$53K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
543 |
543 |
$32K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
296 |
295 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
281 |
280 |
$3K |
| V2025 |
Deluxe frame |
13 |
13 |
$706.88 |
| 92015 |
Determination of refractive state |
1,080 |
1,056 |
$697.69 |