| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
125 |
122 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
40 |
39 |
$4K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
39 |
39 |
$3K |
| V2025 |
Deluxe frame |
43 |
43 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
26 |
26 |
$3K |
| V2020 |
Frames, purchases |
76 |
74 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
137 |
130 |
$949.75 |
| 92015 |
Determination of refractive state |
193 |
193 |
$805.00 |