| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
111 |
101 |
$8K |
| V2020 |
Frames, purchases |
429 |
403 |
$7K |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
258 |
243 |
$3K |
| 92015 |
Determination of refractive state |
337 |
312 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
210 |
112 |
$3K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
33 |
30 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
20 |
12 |
$193.00 |