| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
254 |
249 |
$10K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
170 |
169 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
88 |
88 |
$5K |
| V2020 |
Frames, purchases |
262 |
262 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
80 |
80 |
$3K |
| 92002 |
|
64 |
64 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
24 |
24 |
$960.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$241.50 |
| V2750 |
Anti-reflective coating, per lens |
14 |
14 |
$0.00 |