| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
104 |
78 |
$4K |
| V2020 |
Frames, purchases |
79 |
66 |
$1K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
12 |
12 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
209 |
55 |
$217.50 |
| 92015 |
Determination of refractive state |
130 |
99 |
$181.75 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
169 |
46 |
$0.00 |