| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2020 |
Frames, purchases |
128 |
126 |
$9K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
39 |
39 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
39 |
39 |
$3K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
115 |
113 |
$3K |
| 92015 |
Determination of refractive state |
127 |
126 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
46 |
44 |
$2K |