| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
353 |
353 |
$15K |
| V2020 |
Frames, purchases |
589 |
498 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
254 |
208 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
65 |
65 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
182 |
117 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
14 |
$348.32 |
| 92015 |
Determination of refractive state |
713 |
712 |
$0.00 |