Invoice Detail
Invoice Lines (25 records)
| Practice | Claim # | Patient | Insurance | Resp | DOS | CPT | Category | Qty | Gross Charge | Adjustments | Net Billed |
|---|---|---|---|---|---|---|---|---|---|---|---|
| AEC | CLM-10042 | Johnson, Michael | VSP | Insurance | 11/15/25 | 92004 | Exam | 1 | $250.00 | ($45.00) | $205.00 |
| AEC | CLM-10042 | Johnson, Michael | VSP | Insurance | 11/15/25 | V2020 | Frames | 1 | $185.00 | $0.00 | $185.00 |
| VEO | CLM-20301 | Kim, Sarah | EyeMed | Insurance | 12/10/25 | 92014 | Medical | 1 | $325.00 | ($72.00) | $253.00 |
| SVEP | CLM-50145 | Chang, Lisa | Aetna | Insurance | 12/05/25 | 92004 | Exam | 1 | $275.00 | ($55.00) | $220.00 |
| SVEP | CLM-50145 | Chang, Lisa | Aetna | Insurance | 12/05/25 | V2781 | Lenses | 2 | $340.00 | ($68.00) | $272.00 |
| LAEC | CLM-30198 | Rodriguez, Maria | VSP | Insurance | 12/15/25 | V2020 | Frames | 1 | $280.00 | ($35.00) | $245.00 |
| LAEC | CLM-30198 | Rodriguez, Maria | VSP | Patient | 12/15/25 | V2783 | Lenses | 2 | $420.00 | ($80.00) | $340.00 |
| ECH | CLM-40087 | Nakamura, Keiko | HMSA | Insurance | 11/28/25 | 92014 | Medical | 1 | $310.00 | ($62.00) | $248.00 |
| EKO | CLM-60045 | O'Brien, Patrick | Cigna | Insurance | 11/12/25 | 92004 | Exam | 1 | $240.00 | ($48.00) | $192.00 |
| EKO | CLM-60045 | O'Brien, Patrick | Cigna | Patient | 11/12/25 | V2020 | Frames | 1 | $195.00 | $0.00 | $195.00 |
| AEC | CLM-10088 | Smith, Karen | VSP | Insurance | 12/10/25 | 92004 | Exam | 1 | $250.00 | ($45.00) | $205.00 |
| AEC | CLM-10088 | Smith, Karen | VSP | Insurance | 12/10/25 | S0580 | CL | 4 | $220.00 | ($30.00) | $190.00 |
| VEO | CLM-20234 | Williams, David | EyeMed | Insurance | 11/05/25 | V2020 | Frames | 1 | $310.00 | ($42.00) | $268.00 |
| VEO | CLM-20234 | Williams, David | EyeMed | Insurance | 11/05/25 | V2781 | Lenses | 2 | $290.00 | ($55.00) | $235.00 |
| SVEP | CLM-50278 | Kumar, Arun | United | Insurance | 12/12/25 | 92014 | Medical | 1 | $350.00 | ($70.00) | $280.00 |
| LAEC | CLM-30345 | Hassan, Omar | EyeMed | Insurance | 11/22/25 | 92004 | Exam | 1 | $260.00 | ($52.00) | $208.00 |
| ECH | CLM-40156 | Lee, Samantha | HMSA | Patient | 10/28/25 | V2020 | Frames | 1 | $175.00 | $0.00 | $175.00 |
| AEC | CLM-10122 | Brown, James | Medicare | Insurance | 12/18/25 | 92014 | Medical | 1 | $295.00 | ($59.00) | $236.00 |
| VEO | CLM-20412 | Singh, Robert | VSP | Insurance | 11/18/25 | V2799 | Accessories | 2 | $85.00 | $0.00 | $85.00 |
| SVEP | CLM-50412 | Patel, Ravi | United | Insurance | 11/28/25 | 92004 | Exam | 1 | $275.00 | ($55.00) | $220.00 |
| LAEC | CLM-30478 | Reyes, Carlos | Medicare | Insurance | 12/20/25 | 92014 | Medical | 1 | $320.00 | ($64.00) | $256.00 |
| ECH | CLM-40289 | Kim, Daniel | HMSA | Insurance | 12/01/25 | 92004 | Exam | 1 | $255.00 | ($51.00) | $204.00 |
| EKO | CLM-60134 | Davis, Robert | VSP | Insurance | 10/15/25 | V2020 | Frames | 1 | $225.00 | ($28.00) | $197.00 |
| EKO | CLM-60198 | Martinez, Ana | EyeMed | Insurance | 11/25/25 | 92004 | Exam | 1 | $245.00 | ($49.00) | $196.00 |
| AEC | CLM-10178 | Wilson, Emily | EyeMed | Insurance | 11/08/25 | V2783 | Lenses | 2 | $380.00 | ($76.00) | $304.00 |