| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92015 |
Determination of refractive state |
390 |
321 |
$9K |
| V2020 |
Frames, purchases |
263 |
246 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
42 |
39 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
15 |
13 |
$835.44 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
15 |
14 |
$548.82 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
14 |
14 |
$304.92 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
15 |
12 |
$294.80 |