| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
38 |
38 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
35 |
35 |
$2K |
| V2020 |
Frames, purchases |
74 |
74 |
$2K |
| V2755 |
U-v lens, per lens |
12 |
12 |
$231.96 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
22 |
13 |
$220.00 |
| 92015 |
Determination of refractive state |
177 |
176 |
$20.22 |