| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
98 |
98 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
65 |
65 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
131 |
131 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
64 |
64 |
$3K |
| 92015 |
Determination of refractive state |
374 |
374 |
$2K |
| V2020 |
Frames, purchases |
97 |
97 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
14 |
14 |
$420.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$127.68 |