| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| S0620 |
Routine ophthalmological examination including refraction; new patient |
272 |
266 |
$11K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
94 |
88 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
86 |
86 |
$4K |
| V2020 |
Frames, purchases |
144 |
142 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
27 |
25 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
28 |
$521.94 |
| 92015 |
Determination of refractive state |
64 |
57 |
$447.11 |