| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
380 |
380 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
279 |
278 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
361 |
359 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
245 |
244 |
$4K |
| V2020 |
Frames, purchases |
233 |
230 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
148 |
147 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$649.25 |
| 92015 |
Determination of refractive state |
15 |
15 |
$340.31 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
220 |
219 |
$52.50 |
| V2750 |
Anti-reflective coating, per lens |
71 |
70 |
$0.00 |
| V2025 |
Deluxe frame |
330 |
327 |
$0.00 |