| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,146 |
3,089 |
$136K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,832 |
2,780 |
$122K |
| V2020 |
Frames, purchases |
3,149 |
3,077 |
$61K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,862 |
2,827 |
$48K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,077 |
1,046 |
$28K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,710 |
1,680 |
$23K |
| 92015 |
Determination of refractive state |
507 |
494 |
$10K |
| V2025 |
Deluxe frame |
305 |
303 |
$3K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
29 |
29 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
41 |
40 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,220 |
1,187 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
133 |
132 |
$2K |
| 92060 |
|
12 |
12 |
$730.96 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
13 |
13 |
$663.25 |
| V2750 |
Anti-reflective coating, per lens |
111 |
110 |
$0.00 |