| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
257 |
254 |
$17K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
414 |
403 |
$13K |
| V2020 |
Frames, purchases |
468 |
427 |
$12K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
116 |
112 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
195 |
191 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
300 |
283 |
$2K |
| 92015 |
Determination of refractive state |
244 |
228 |
$2K |
| 92250 |
|
14 |
13 |
$628.59 |
| V2760 |
Scratch resistant coating, per lens |
288 |
275 |
$442.02 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
18 |
15 |
$246.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
14 |
$199.40 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
12 |
12 |
$110.10 |
| S9999 |
Sales tax |
12 |
12 |
$21.42 |