| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,366 |
2,341 |
$72K |
| 92002 |
|
1,750 |
1,739 |
$69K |
| V2025 |
Deluxe frame |
1,246 |
1,240 |
$60K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,239 |
1,211 |
$48K |
| V2020 |
Frames, purchases |
952 |
937 |
$19K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
176 |
165 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,186 |
1,170 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
77 |
75 |
$3K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
30 |
30 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
59 |
59 |
$157.29 |
| 92015 |
Determination of refractive state |
3,777 |
3,716 |
$148.92 |
| 92310 |
|
130 |
130 |
$0.00 |