| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
296 |
296 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
480 |
239 |
$10K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
169 |
169 |
$9K |
| V2020 |
Frames, purchases |
758 |
753 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
410 |
204 |
$9K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
38 |
38 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,616 |
806 |
$720.00 |
| 92015 |
Determination of refractive state |
85 |
85 |
$0.00 |