| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
946 |
933 |
$59K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
359 |
356 |
$32K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
474 |
460 |
$31K |
| 92002 |
|
110 |
107 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
139 |
120 |
$5K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
53 |
53 |
$2K |
| 92015 |
Determination of refractive state |
154 |
148 |
$2K |
| S0516 |
Safety eyeglass frames |
48 |
48 |
$767.04 |
| V2020 |
Frames, purchases |
180 |
95 |
$667.50 |
| 92370 |
|
25 |
24 |
$638.00 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
48 |
48 |
$443.22 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
141 |
73 |
$229.00 |
| S9999 |
Sales tax |
61 |
61 |
$98.67 |