| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,624 |
1,473 |
$102K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,264 |
1,090 |
$100K |
| V2020 |
Frames, purchases |
2,966 |
2,324 |
$64K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,736 |
1,600 |
$46K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,144 |
1,316 |
$23K |
| V2755 |
U-v lens, per lens |
908 |
776 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
969 |
768 |
$5K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
372 |
205 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
194 |
144 |
$2K |
| 92341 |
|
40 |
40 |
$1K |
| S0516 |
Safety eyeglass frames |
34 |
33 |
$540.60 |
| 92015 |
Determination of refractive state |
2,954 |
2,609 |
$466.34 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
34 |
33 |
$311.18 |
| S9999 |
Sales tax |
104 |
104 |
$150.12 |
| V2760 |
Scratch resistant coating, per lens |
44 |
28 |
$26.00 |