| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,935 |
1,836 |
$64K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
674 |
663 |
$62K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
765 |
754 |
$61K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
897 |
747 |
$34K |
| 92015 |
Determination of refractive state |
1,919 |
1,884 |
$22K |
| V2755 |
U-v lens, per lens |
543 |
538 |
$12K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
18 |
12 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
18 |
14 |
$621.16 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14 |
14 |
$560.00 |