| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2020 |
Frames, purchases |
128 |
121 |
$2K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
39 |
39 |
$2K |
| 92015 |
Determination of refractive state |
305 |
260 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
56 |
56 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
33 |
24 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
61 |
57 |
$662.90 |