| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
5,172 |
5,094 |
$349K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,474 |
2,425 |
$224K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,366 |
5,273 |
$172K |
| V2020 |
Frames, purchases |
6,759 |
5,713 |
$134K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,067 |
3,958 |
$82K |
| 92015 |
Determination of refractive state |
2,092 |
2,071 |
$41K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,503 |
4,552 |
$34K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,492 |
886 |
$7K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
56 |
51 |
$4K |
| V2760 |
Scratch resistant coating, per lens |
1,703 |
1,680 |
$3K |
| S0516 |
Safety eyeglass frames |
196 |
195 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
89 |
87 |
$3K |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
206 |
205 |
$2K |
| 92370 |
|
26 |
26 |
$725.00 |
| S9999 |
Sales tax |
375 |
373 |
$699.45 |
| 92341 |
|
13 |
13 |
$494.00 |