| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
7,081 |
6,418 |
$395K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
3,869 |
3,566 |
$370K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
3,891 |
3,644 |
$263K |
| V2020 |
Frames, purchases |
5,725 |
5,691 |
$244K |
| 92250 |
|
4,954 |
4,362 |
$141K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,767 |
2,727 |
$139K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,923 |
1,788 |
$125K |
| 92015 |
Determination of refractive state |
9,865 |
8,048 |
$108K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,166 |
1,005 |
$52K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,106 |
1,098 |
$37K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
193 |
191 |
$14K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
146 |
121 |
$6K |
| V2025 |
Deluxe frame |
81 |
81 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
502 |
500 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
142 |
141 |
$981.25 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
24 |
24 |
$911.10 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$534.51 |
| 1036F |
|
73 |
57 |
$0.00 |