| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,661 |
4,418 |
$290K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,492 |
2,378 |
$211K |
| V2020 |
Frames, purchases |
7,293 |
6,560 |
$198K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
6,344 |
6,148 |
$175K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
2,636 |
2,541 |
$118K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
5,690 |
5,384 |
$112K |
| 92002 |
|
1,194 |
1,151 |
$58K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,587 |
4,210 |
$33K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
756 |
636 |
$27K |
| V2599 |
Contact lens, other type |
126 |
123 |
$11K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
358 |
331 |
$10K |
| V2760 |
Scratch resistant coating, per lens |
3,741 |
3,617 |
$8K |
| 92250 |
|
29 |
27 |
$1K |
| S0516 |
Safety eyeglass frames |
62 |
62 |
$990.76 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
63 |
62 |
$591.42 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
75 |
38 |
$416.00 |
| 92370 |
|
14 |
14 |
$290.00 |
| S9999 |
Sales tax |
139 |
138 |
$186.63 |
| 2023F |
|
712 |
695 |
$0.00 |
| G8732 |
No documentation of pain assessment, reason not given |
30 |
27 |
$0.00 |
| 99199 |
Unlisted special service, procedure or report |
27 |
24 |
$0.00 |