| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,096 |
1,079 |
$65K |
| V2020 |
Frames, purchases |
1,862 |
1,600 |
$38K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
438 |
433 |
$32K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,145 |
1,124 |
$30K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,726 |
998 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,092 |
876 |
$5K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
107 |
98 |
$5K |
| V2755 |
U-v lens, per lens |
396 |
390 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
380 |
250 |
$3K |
| 92015 |
Determination of refractive state |
1,746 |
1,710 |
$1K |
| 92250 |
|
44 |
39 |
$1K |
| S0516 |
Safety eyeglass frames |
39 |
39 |
$624.24 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
46 |
25 |
$435.00 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
39 |
39 |
$357.74 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
22 |
15 |
$152.00 |
| S9999 |
Sales tax |
50 |
50 |
$76.53 |