| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
369 |
243 |
$8K |
| V2020 |
Frames, purchases |
321 |
314 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
95 |
95 |
$4K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
62 |
62 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
165 |
160 |
$2K |
| 92015 |
Determination of refractive state |
67 |
67 |
$870.20 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
168 |
111 |
$378.00 |