| Code | Description | Claims | Bene. Records | Total Paid |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
7,748 |
7,711 |
$248K |
| V2020 |
Frames, purchases |
13,198 |
13,129 |
$246K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
8,784 |
7,366 |
$180K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,609 |
3,592 |
$119K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,923 |
3,633 |
$78K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,866 |
1,845 |
$19K |
| 92015 |
Determination of refractive state |
2,793 |
2,770 |
$11K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
672 |
387 |
$10K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
428 |
249 |
$8K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
271 |
271 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
7,208 |
3,914 |
$7K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
176 |
176 |
$5K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
99 |
59 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
141 |
78 |
$1K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
31 |
16 |
$310.56 |
| V2755 |
U-v lens, per lens |
1,470 |
735 |
$0.00 |