| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
10,113 |
3,053 |
$276K |
| V2020 |
Frames, purchases |
5,706 |
3,504 |
$191K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,229 |
3,162 |
$135K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,147 |
1,119 |
$49K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
9,418 |
2,714 |
$9K |
| 92015 |
Determination of refractive state |
1,912 |
1,861 |
$236.25 |