| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
249 |
249 |
$14K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
187 |
187 |
$8K |
| V2020 |
Frames, purchases |
868 |
847 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
356 |
347 |
$390.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
358 |
348 |
$240.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
285 |
277 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
54 |
50 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
253 |
248 |
$0.00 |