| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92250 |
|
680 |
663 |
$31K |
| V2020 |
Frames, purchases |
1,285 |
1,276 |
$17K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
981 |
550 |
$17K |
| 92083 |
|
328 |
323 |
$16K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
226 |
223 |
$13K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
88 |
88 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
93 |
58 |
$995.44 |
| 92015 |
Determination of refractive state |
63 |
63 |
$732.00 |
| 92133 |
|
13 |
13 |
$394.09 |
| 76514 |
|
12 |
12 |
$44.21 |
| V2755 |
U-v lens, per lens |
278 |
138 |
$0.00 |