| 86287-0 | R ret RNFL inf temp thickness OCT | required |
| 86289-6 | L ret RNFL inf temp thickness OCT | required |
| 86283-9 | R ret RNFL inf thickness OCT | required |
| 86288-8 | L ret RNFL inf thickness OCT | required |
| 86290-4 | L ret RNFL mean thickness OCT | required |
| 86301-9 | R ret RNFL mean thickness OCT | required |
| 86272-2 | L ret RNFL nasal inf thickness OCT | required |
| 86282-1 | R ret RNFL nasal inf thickness OCT | required |
| 86280-5 | R ret RNFL nasal sup thickness OCT | required |
| 86281-3 | L ret RNFL nasal sup thickness OCT | required |
| 86279-7 | L ret RNFL nasal thickness OCT | required |
| 86284-7 | R ret RNFL nasal thickness OCT | required |
| 86276-3 | R ret RNFL sup thickness OCT | required |
| 86277-1 | L ret RNFL sup thickness OCT | required |
| 86274-8 | R ret RNFL temp sup thickness OCT | required |
| 86275-5 | L ret RNFL temp sup thickness OCT | required |
| 86273-0 | R ret RNFL temp thickness OCT | required |
| 86278-9 | L ret RNFL temp thickness OCT | required |
| 86293-8 | L ret RNFL 1 o'clock thickness OCT | optional |
| 86305-0 | R ret RNFL 1 o'clock thickness OCT | optional |
| 86294-6 | L ret RNFL 2 o'clock thickness OCT | optional |
| 86306-8 | R ret RNFL 2 o'clock thickness OCT | optional |
| 86295-3 | L ret RNFL 3 o'clock thickness OCT | optional |
| 86307-6 | R ret RNFL 3 o'clock thickness OCT | optional |
| 86296-1 | L ret RNFL 4 o'clock thickness OCT | optional |
| 86308-4 | R ret RNFL 4 o'clock thickness OCT | optional |
| 86297-9 | L ret RNFL 5 o'clock thickness OCT | optional |
| 86309-2 | R ret RNFL 5 o'clock thickness OCT | optional |
| 86298-7 | L ret RNFL 6 o'clock thickness OCT | optional |
| 86310-0 | R ret RNFL 6 o'clock thickness OCT | optional |
| 86299-5 | L ret RNFL 7 o'clock thickness OCT | optional |
| 86311-8 | R ret RNFL 7 o'clock thickness OCT | optional |
| 86300-1 | L ret RNFL 8 o'clock thickness OCT | optional |
| 86312-6 | R ret RNFL 8 o'clock thickness OCT | optional |
| 86286-2 | L ret RNFL 9 o'clock thickness OCT | optional |
| 86313-4 | R ret RNFL 9 o'clock thickness OCT | optional |
| 86302-7 | L ret RNFL 10 o'clock thickness OCT | optional |
| 86314-2 | R ret RNFL 10 o'clock thickness OCT | optional |
| 86303-5 | L ret RNFL 11 o'clock thickness OCT | optional |
| 86315-9 | R ret RNFL 11 o'clock thickness OCT | optional |
| 86304-3 | R ret RNFL 12 o'clock thickness OCT | optional |
| 86292-0 | L ret RNFL 12 o'clock thickness OCT | optional |
| 86291-2 | Retina RNFL Pnl OCT | |