| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,667 |
2,614 |
$176K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,869 |
2,808 |
$163K |
| V2020 |
Frames, purchases |
2,276 |
2,266 |
$97K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,368 |
1,331 |
$80K |
| 92015 |
Determination of refractive state |
1,608 |
1,534 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
300 |
296 |
$18K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
42 |
42 |
$2K |
| 92310 |
|
12 |
12 |
$1K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
24 |
24 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$1K |
| 92250 |
|
24 |
24 |
$904.52 |
| V2025 |
Deluxe frame |
26 |
26 |
$713.28 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
161 |
160 |
$199.00 |
| 99199 |
Unlisted special service, procedure or report |
87 |
86 |
$0.00 |
| G8427 |
Eligible clinician attests to documenting in the medical record they obtained, updated, or reviewed the patient's current medications |
39 |
36 |
$0.00 |