| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
223 |
220 |
$20K |
| V2020 |
Frames, purchases |
225 |
208 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
89 |
88 |
$7K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
201 |
185 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
118 |
65 |
$3K |
| 92015 |
Determination of refractive state |
265 |
263 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
84 |
74 |
$920.00 |