| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
282 |
281 |
$20K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
138 |
138 |
$13K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
273 |
272 |
$9K |
| V2020 |
Frames, purchases |
423 |
338 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
206 |
170 |
$3K |
| 92015 |
Determination of refractive state |
466 |
464 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
372 |
301 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
17 |
14 |
$682.08 |
| V2760 |
Scratch resistant coating, per lens |
238 |
238 |
$474.02 |
| 92341 |
|
15 |
14 |
$439.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
31 |
28 |
$344.01 |
| S0516 |
Safety eyeglass frames |
14 |
14 |
$223.72 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
14 |
14 |
$129.86 |
| S9999 |
Sales tax |
14 |
14 |
$24.84 |