| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
472 |
324 |
$25K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
480 |
372 |
$22K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
105 |
58 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
322 |
286 |
$15K |
| V2025 |
Deluxe frame |
494 |
333 |
$7K |
| 92015 |
Determination of refractive state |
314 |
309 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
161 |
159 |
$5K |
| V2020 |
Frames, purchases |
143 |
139 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
60 |
57 |
$3K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
44 |
42 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
29 |
29 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
137 |
136 |
$400.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16 |
16 |
$203.00 |
| V2750 |
Anti-reflective coating, per lens |
78 |
35 |
$0.00 |