| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
4,059 |
3,904 |
$354K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
4,482 |
4,326 |
$287K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
6,276 |
5,987 |
$180K |
| V2020 |
Frames, purchases |
9,069 |
6,932 |
$160K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,207 |
3,688 |
$67K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,963 |
3,652 |
$21K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
971 |
903 |
$17K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
326 |
278 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,152 |
1,231 |
$10K |
| 92341 |
|
217 |
211 |
$8K |
| 92015 |
Determination of refractive state |
321 |
314 |
$6K |
| 92370 |
|
164 |
162 |
$4K |
| S0516 |
Safety eyeglass frames |
264 |
261 |
$4K |
| V2760 |
Scratch resistant coating, per lens |
2,297 |
2,109 |
$4K |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
259 |
257 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
178 |
104 |
$1K |
| S9999 |
Sales tax |
534 |
519 |
$733.23 |
| 92250 |
|
25 |
24 |
$656.14 |
| 92083 |
|
15 |
15 |
$515.09 |