| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
51 |
25 |
$889.00 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
119 |
72 |
$741.36 |
| V2020 |
Frames, purchases |
165 |
71 |
$723.60 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
12 |
$231.60 |
| 92015 |
Determination of refractive state |
211 |
125 |
$0.00 |