| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
304 |
304 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
77 |
77 |
$6K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
69 |
69 |
$5K |
| V2020 |
Frames, purchases |
141 |
141 |
$3K |
| V2025 |
Deluxe frame |
44 |
44 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
343 |
343 |
$223.08 |
| 92015 |
Determination of refractive state |
362 |
362 |
$223.08 |