| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
176 |
176 |
$14K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
232 |
230 |
$9K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
108 |
107 |
$7K |
| 92015 |
Determination of refractive state |
582 |
576 |
$4K |
| V2020 |
Frames, purchases |
125 |
125 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
25 |
25 |
$720.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$115.52 |