| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
900 |
883 |
$85K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,191 |
1,165 |
$82K |
| V2020 |
Frames, purchases |
1,835 |
1,542 |
$42K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,130 |
1,069 |
$35K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
445 |
430 |
$20K |
| 92002 |
|
292 |
285 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
879 |
719 |
$13K |
| 92015 |
Determination of refractive state |
2,379 |
2,314 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
333 |
301 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
854 |
697 |
$5K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
50 |
43 |
$2K |
| 92250 |
|
55 |
51 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
451 |
418 |
$858.98 |
| S0516 |
Safety eyeglass frames |
29 |
29 |
$463.42 |
| 92341 |
|
13 |
13 |
$449.00 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
30 |
30 |
$282.30 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16 |
13 |
$250.00 |
| S9999 |
Sales tax |
64 |
63 |
$91.29 |