| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
302 |
302 |
$31K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
229 |
229 |
$28K |
| V2020 |
Frames, purchases |
763 |
721 |
$22K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
787 |
755 |
$18K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
479 |
458 |
$13K |
| 92015 |
Determination of refractive state |
723 |
714 |
$11K |
| V2025 |
Deluxe frame |
193 |
193 |
$9K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
108 |
101 |
$8K |
| V2750 |
Anti-reflective coating, per lens |
356 |
343 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
55 |
55 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
136 |
133 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
94 |
93 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
43 |
43 |
$3K |
| 92250 |
|
14 |
14 |
$926.36 |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
13 |
13 |
$536.13 |
| 92133 |
|
12 |
12 |
$403.86 |