| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,980 |
3,718 |
$250K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
4,629 |
4,290 |
$247K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,796 |
2,528 |
$220K |
| 92250 |
|
1,212 |
1,051 |
$33K |
| 92015 |
Determination of refractive state |
5,935 |
5,432 |
$22K |
| 92341 |
|
372 |
355 |
$22K |
| V2020 |
Frames, purchases |
600 |
372 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
79 |
65 |
$2K |
| 92370 |
|
31 |
31 |
$841.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
124 |
72 |
$583.40 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
31 |
25 |
$485.60 |
| S0516 |
Safety eyeglass frames |
14 |
14 |
$207.74 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
14 |
14 |
$125.62 |
| S9999 |
Sales tax |
28 |
28 |
$49.89 |