| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2020 |
Frames, purchases |
623 |
509 |
$7K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
218 |
173 |
$7K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
174 |
158 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
242 |
183 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
278 |
179 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
68 |
62 |
$2K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
74 |
74 |
$799.09 |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
14 |
14 |
$208.26 |
| 92015 |
Determination of refractive state |
131 |
105 |
$79.84 |
| 99211 |
Office or other outpatient visit for the evaluation and management of an established patient, minimal severity |
14 |
12 |
$0.00 |