| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
368 |
355 |
$29K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,112 |
1,086 |
$21K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
287 |
279 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
598 |
580 |
$18K |
| V2020 |
Frames, purchases |
770 |
741 |
$15K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
115 |
115 |
$8K |
| 92015 |
Determination of refractive state |
1,073 |
1,047 |
$5K |
| V2025 |
Deluxe frame |
94 |
94 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
24 |
$711.29 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
32 |
31 |
$316.48 |