| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
435 |
425 |
$26K |
| V2020 |
Frames, purchases |
187 |
182 |
$8K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
65 |
65 |
$7K |
| 92015 |
Determination of refractive state |
1,066 |
1,055 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
54 |
27 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
23 |
14 |
$215.46 |