| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
913 |
887 |
$82K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
976 |
956 |
$65K |
| 92015 |
Determination of refractive state |
2,368 |
2,296 |
$24K |
| V2020 |
Frames, purchases |
1,113 |
896 |
$21K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
702 |
665 |
$21K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
617 |
529 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
406 |
268 |
$4K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
67 |
56 |
$3K |
| V2760 |
Scratch resistant coating, per lens |
106 |
104 |
$2K |
| S0516 |
Safety eyeglass frames |
15 |
15 |
$239.70 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
15 |
15 |
$134.10 |
| S9999 |
Sales tax |
27 |
27 |
$90.39 |