| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,400 |
1,322 |
$66K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
621 |
601 |
$55K |
| 92015 |
Determination of refractive state |
2,567 |
2,464 |
$18K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
325 |
320 |
$15K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
55 |
55 |
$4K |
| V2020 |
Frames, purchases |
332 |
215 |
$926.25 |
| 92002 |
|
14 |
14 |
$723.38 |
| S0516 |
Safety eyeglass frames |
29 |
29 |
$463.42 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
29 |
29 |
$261.14 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
140 |
70 |
$227.00 |
| S9999 |
Sales tax |
29 |
29 |
$81.51 |