| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
919 |
803 |
$22K |
| V2020 |
Frames, purchases |
1,021 |
910 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
348 |
286 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
501 |
448 |
$4K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
189 |
138 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
39 |
39 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
28 |
$510.06 |
| 92250 |
|
13 |
13 |
$434.92 |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
16 |
15 |
$232.14 |
| 92015 |
Determination of refractive state |
32 |
27 |
$0.00 |