| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92015 |
Determination of refractive state |
799 |
735 |
$10K |
| 92250 |
|
149 |
140 |
$4K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
132 |
129 |
$3K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
34 |
29 |
$1K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
12 |
12 |
$590.28 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
14 |
$348.32 |
| V2020 |
Frames, purchases |
16 |
16 |
$320.00 |