| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,852 |
1,785 |
$113K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,076 |
1,048 |
$98K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
834 |
816 |
$56K |
| 92015 |
Determination of refractive state |
2,536 |
2,460 |
$12K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
159 |
111 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
64 |
62 |
$4K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
14 |
12 |
$711.36 |
| 92250 |
|
12 |
12 |
$546.02 |
| S0516 |
Safety eyeglass frames |
34 |
33 |
$543.32 |
| V2020 |
Frames, purchases |
143 |
73 |
$532.50 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
35 |
34 |
$309.14 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
68 |
34 |
$118.00 |
| S9999 |
Sales tax |
35 |
34 |
$86.25 |