| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,958 |
3,957 |
$175K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
7,097 |
3,444 |
$142K |
| V2020 |
Frames, purchases |
5,098 |
4,939 |
$59K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
554 |
554 |
$27K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
930 |
463 |
$19K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
370 |
182 |
$10K |
| 92015 |
Determination of refractive state |
1,215 |
1,215 |
$5K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
95 |
95 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
10,757 |
5,237 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
93 |
93 |
$1K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
34 |
34 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
24 |
12 |
$492.96 |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
32 |
30 |
$461.59 |