| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,382 |
4,332 |
$329K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,897 |
3,874 |
$258K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
4,749 |
4,711 |
$132K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,749 |
4,703 |
$113K |
| V2020 |
Frames, purchases |
6,181 |
6,127 |
$112K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,734 |
2,708 |
$51K |
| 92015 |
Determination of refractive state |
9,461 |
9,367 |
$39K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
242 |
242 |
$18K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,260 |
1,259 |
$13K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
175 |
152 |
$9K |
| V2025 |
Deluxe frame |
285 |
285 |
$9K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
326 |
326 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
42 |
41 |
$1K |
| 92341 |
|
13 |
13 |
$529.41 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
14 |
14 |
$521.21 |
| V2744 |
Tint, photochromatic, per lens |
31 |
31 |
$480.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$204.82 |
| V2750 |
Anti-reflective coating, per lens |
477 |
472 |
$0.00 |