| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
192 |
189 |
$12K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
116 |
113 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
27 |
27 |
$3K |
| V2020 |
Frames, purchases |
22 |
18 |
$446.25 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
12 |
$264.60 |
| 92015 |
Determination of refractive state |
543 |
531 |
$181.98 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
20 |
17 |
$104.00 |