| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92015 |
Determination of refractive state |
29 |
25 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
47 |
46 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
124 |
118 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
74 |
44 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
28 |
17 |
$0.00 |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$0.00 |