| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2020 |
Frames, purchases |
120 |
119 |
$4K |
| 92250 |
|
94 |
92 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
77 |
59 |
$1K |
| 92015 |
Determination of refractive state |
53 |
52 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
34 |
33 |
$931.06 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
65 |
64 |
$833.72 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
16 |
16 |
$487.05 |