| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,567 |
2,372 |
$131K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,059 |
1,863 |
$122K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,017 |
913 |
$82K |
| 92250 |
|
628 |
476 |
$18K |
| 92015 |
Determination of refractive state |
3,558 |
3,213 |
$9K |
| 92341 |
|
146 |
126 |
$6K |
| V2020 |
Frames, purchases |
3,929 |
2,933 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
714 |
437 |
$3K |
| S0516 |
Safety eyeglass frames |
89 |
89 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,200 |
1,673 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,593 |
1,591 |
$962.00 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
89 |
89 |
$790.48 |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
13 |
13 |
$671.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
20 |
12 |
$426.30 |
| S9999 |
Sales tax |
197 |
197 |
$318.51 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
17 |
12 |
$90.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
167 |
84 |
$60.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
23 |
21 |
$12.00 |