| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2020 |
Frames, purchases |
186 |
186 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
29 |
29 |
$980.00 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
27 |
27 |
$930.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
24 |
24 |
$547.36 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
27 |
27 |
$168.00 |
| 92015 |
Determination of refractive state |
208 |
208 |
$0.00 |