| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
890 |
881 |
$61K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
918 |
907 |
$43K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
464 |
459 |
$42K |
| V2020 |
Frames, purchases |
859 |
638 |
$14K |
| 92015 |
Determination of refractive state |
869 |
859 |
$8K |
| 92341 |
|
97 |
96 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
337 |
266 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
489 |
408 |
$3K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
54 |
50 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
417 |
414 |
$824.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
63 |
50 |
$736.00 |
| S0516 |
Safety eyeglass frames |
29 |
29 |
$463.42 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
29 |
29 |
$269.60 |
| S9999 |
Sales tax |
56 |
54 |
$101.79 |