| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
245 |
244 |
$17K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
247 |
244 |
$16K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
286 |
285 |
$8K |
| V2020 |
Frames, purchases |
240 |
239 |
$4K |
| 92015 |
Determination of refractive state |
935 |
921 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
104 |
103 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
31 |
31 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
13 |
13 |
$937.81 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
33 |
33 |
$316.16 |