| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2020 |
Frames, purchases |
225 |
203 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
156 |
82 |
$5K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
120 |
120 |
$5K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
96 |
95 |
$4K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
40 |
40 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
28 |
28 |
$980.50 |
| 92015 |
Determination of refractive state |
41 |
41 |
$760.00 |
| 92250 |
|
12 |
12 |
$644.58 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
16 |
16 |
$558.16 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
60 |
24 |
$240.00 |