Carol a Balfe, Od, PC
Carol a Balfe, Od, PC was paid $217K by Medicaid between Jan 2018 and Dec 2024, across 11 billing codes. Its largest line is V2100, Sphere, single vision, plano to plus or minus 4.00, per lens — 27% of everything it billed.
33Billing provider infoCAROL A BALFE, OD, PC
CANAJOHARIE, NY 13317
CANAJOHARIE, NY 13317
33aNPI1366640567assigned 07/10/2007
33bProvider typeOptometrist
28Total paid$217K
24GClaims13,194
24DCodes billed11
24AFirst – last monthJan 2018 – Dec 2024
Compared with peers
Next to other Optometrist providers in New York
Rank by total paid#376 of 1,605
Median peer was paid$29K
This provider vs. median7.4×
Peers share this provider's primary NPPES type and state. Size alone says nothing about billing quality: a big agency or a hospital system is expected to sit far above the median.
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 | 814 | $6K | |
| 2019 | 1,742 | $24K | |
| 2020 | 2,285 | $35K | |
| 2021 | 2,259 | $39K | |
| 2022 | 2,217 | $42K | |
| 2023 | 2,247 | $40K | |
| 2024incomplete | 1,630 | $31K |
Box 24 · Service lines
What it billed for
| Code | Service | Share | Claims | Bene. records | Paid |
|---|---|---|---|---|---|
| V2100 | Sphere, single vision, plano to plus or minus 4.00, per lens | 27% | 2,898 | 1,387 | $58K |
| 92014 | Ophthalmological services: medical examination and evaluation, comprehensive, established patient | 24% | 1,249 | 1,243 | $52K |
| V2020 | Frames, purchases | 17% | 2,723 | 2,636 | $36K |
| 99215 | Doctor's office visit, returning patient (complex)Prolong outpt/office vis | 16% | 487 | 468 | $35K |
| 92004 | Ophthalmological services: medical examination and evaluation, comprehensive, new patient | 6.7% | 339 | 339 | $14K |
| V2784 | Lens, polycarbonate or equal, any index, per lens | 5.6% | 5,085 | 2,612 | $12K |
| V2103 | Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens | 3.1% | 328 | 164 | $7K |
| 99204 | Doctor's office visit, new patient (more involved)Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity | <1% | 12 | 12 | $1K |
| V2200 | Sphere, bifocal, plano to plus or minus 4.00d, per lens | <1% | 28 | 14 | $800.24 |
| S0621 | Routine ophthalmological examination including refraction; established patient | <1% | 16 | 16 | $640.00 |
| 92015 | Determination of refractive state | 0% | 29 | 29 | $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.
From NPPES
Who's on the registration
Authorized officialBALFE, CAROL (OWNER)