| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
77 |
76 |
$678.36 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
153 |
151 |
$666.86 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
24 |
24 |
$158.85 |
| V2020 |
Frames, purchases |
141 |
140 |
$8.70 |
| V2756 |
Eye glass case |
165 |
163 |
$0.00 |
| 3072F |
|
120 |
120 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
82 |
41 |
$0.00 |
| 92342 |
|
165 |
163 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
19 |
12 |
$0.00 |
| 92015 |
Determination of refractive state |
138 |
137 |
$0.00 |
| 2022F |
|
120 |
120 |
$0.00 |