| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
5,040 |
4,727 |
$322K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
2,848 |
2,624 |
$240K |
| V2020 |
Frames, purchases |
5,769 |
5,120 |
$162K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,151 |
4,895 |
$136K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,109 |
1,906 |
$33K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,670 |
1,510 |
$26K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
508 |
433 |
$19K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,707 |
2,440 |
$18K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
186 |
148 |
$7K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
352 |
310 |
$7K |
| V2760 |
Scratch resistant coating, per lens |
2,361 |
2,236 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
122 |
99 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
51 |
40 |
$639.52 |
| S0516 |
Safety eyeglass frames |
31 |
31 |
$495.38 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
32 |
32 |
$290.78 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
17 |
17 |
$280.00 |
| S9999 |
Sales tax |
63 |
63 |
$105.72 |
| 99199 |
Unlisted special service, procedure or report |
19 |
19 |
$0.00 |