Claim CLM-2026185002
$2,730.98
billed
$2,381.33
allowed
$2,070.72
paid
$310.61
patient responsibility
Adjudication lines
| Service | Code | Billed | Paid |
|---|---|---|---|
| Ophthalmic examination and evaluation (procedure) | 36228007 | $0.00 | $0.00 |
| Visual acuity testing (procedure) | 16830007 | $431.40 | $301.98 |
| Intraocular pressure test (procedure) | 252832004 | $431.40 | $301.98 |
| Ocular slit lamp examination (procedure) | 55468007 | $431.40 | $301.98 |