| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,851 |
1,762 |
$162K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,684 |
1,610 |
$109K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,806 |
2,679 |
$79K |
| V2020 |
Frames, purchases |
4,022 |
3,330 |
$71K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,730 |
2,488 |
$54K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,840 |
2,388 |
$18K |
| 92015 |
Determination of refractive state |
3,332 |
3,143 |
$17K |
| V2760 |
Scratch resistant coating, per lens |
1,463 |
1,368 |
$2K |
| V2750 |
Anti-reflective coating, per lens |
120 |
117 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
297 |
162 |
$1K |
| S0516 |
Safety eyeglass frames |
48 |
48 |
$767.04 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
81 |
81 |
$766.44 |
| S9999 |
Sales tax |
170 |
170 |
$317.64 |
| 99199 |
Unlisted special service, procedure or report |
23 |
19 |
$0.00 |
| 2026F |
|
20 |
20 |
$0.00 |
| 2023F |
|
140 |
138 |
$0.00 |
| 2033F |
|
14 |
14 |
$0.00 |