| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
159 |
159 |
$12K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
162 |
162 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
27 |
27 |
$3K |
| V2020 |
Frames, purchases |
14 |
14 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
16 |
16 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
13 |
13 |
$1K |
| 92015 |
Determination of refractive state |
103 |
103 |
$609.00 |
| V2025 |
Deluxe frame |
15 |
15 |
$354.30 |