| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2020 |
Frames, purchases |
86 |
86 |
$8K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
45 |
45 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
46 |
46 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
85 |
85 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
86 |
86 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$991.52 |
| 92015 |
Determination of refractive state |
74 |
74 |
$550.20 |