AR ($185K)
| Code | Description | Total Paid |
|---|---|---|
| L7520 | Repair prosthetic device, labor component, per 15 minutes | $85K |
| V2628 | Fabrication and fitting of ocular conformer | $35K |
| V2623 | Prosthetic eye, plastic, custom | $33K |
| V2624 | Polishing/resurfacing of ocular prosthesis | $32K |
| # | Provider | Location | Claims | Total Paid |
|---|---|---|---|---|
| 1 | ALLOPLASTIC RECONSTRUCTION | LITTLE ROCK, AR | 2,682 | $185K |