| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
976 |
923 |
$42K |
| V2020 |
Frames, purchases |
1,382 |
1,308 |
$27K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
413 |
397 |
$17K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
343 |
327 |
$16K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
221 |
213 |
$10K |
| 92015 |
Determination of refractive state |
59 |
58 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
31 |
31 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
30 |
29 |
$1K |
| V2025 |
Deluxe frame |
16 |
16 |
$197.58 |