| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
165 |
165 |
$78.00 |
| V2020 |
Frames, purchases |
180 |
180 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
28 |
14 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
69 |
69 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
270 |
135 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
134 |
67 |
$0.00 |