| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
5,263 |
5,025 |
$455K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,293 |
4,128 |
$278K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,161 |
2,103 |
$128K |
| 92015 |
Determination of refractive state |
8,573 |
8,195 |
$49K |
| V2020 |
Frames, purchases |
179 |
103 |
$592.50 |
| S0516 |
Safety eyeglass frames |
22 |
21 |
$351.56 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
22 |
21 |
$206.08 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
31 |
15 |
$126.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
75 |
44 |
$96.00 |
| S9999 |
Sales tax |
35 |
35 |
$60.87 |