1104825900

1104825900 was paid $667K by Medicaid between Jan 2018 and Apr 2022, across 15 billing codes. Its largest line is 92014, Ophthalmological services: medical examination and evaluation, comprehensive, established patient — 31% of everything it billed.

33Billing provider info1104825900

33aNPI1104825900

33bProvider type—

28Total paid$667K

24GClaims17,705

24DCodes billed15

24AFirst – last monthJan 2018 – Apr 2022

Box 24A · Dates of service

Paid by month

Paid that monthNov–Dec 2024: claims still arriving when the file was cut, so these months run low for every provider

By year, as a table

Year	Claims	Paid
2018	4,642	$142K
2019	5,459	$224K
2020	2,362	$100K
2021	4,489	$170K
2022	753	$31K

Box 24 · Service lines

What it billed for

Code	Service	Share	Claims	Bene. records	Paid
92014	Ophthalmological services: medical examination and evaluation, comprehensive, established patient	31%	2,616	2,426	$209K
V2020	Frames, purchases	17%	4,182	3,747	$112K
92004	Ophthalmological services: medical examination and evaluation, comprehensive, new patient	14%	954	858	$91K
V2103	Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens	10%	1,610	1,366	$67K
92250		7.3%	1,143	1,030	$49K
92015	Determination of refractive state	7.0%	3,747	3,465	$47K
V2755	U-v lens, per lens	6.4%	1,985	1,844	$43K
V2100	Sphere, single vision, plano to plus or minus 4.00, per lens	4.4%	958	857	$29K
V2203	Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens	2.3%	316	231	$15K
V2104	Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens	<1%	44	41	$2K
V2200	Sphere, bifocal, plano to plus or minus 4.00d, per lens	<1%	46	38	$1K
V2784	Lens, polycarbonate or equal, any index, per lens	<1%	51	50	$633.00

3 more codes

V2299	Specialty bifocal (by report)	<1%	13	$490.10
V2750	Anti-reflective coating, per lens	<1%	25	$85.04
V2781	Progressive lens, per lens	0%	15	$0.00

Claims and beneficiary counts add up across code × month rows, so one patient seen every month counts many times. Rows with fewer than 12 claims are suppressed by HHS, so small lines can be missing.