| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,551 |
1,510 |
$102K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,049 |
1,026 |
$93K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,603 |
1,569 |
$85K |
| V2020 |
Frames, purchases |
609 |
525 |
$13K |
| 92015 |
Determination of refractive state |
1,200 |
1,186 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
360 |
306 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
332 |
291 |
$2K |
| 92341 |
|
24 |
24 |
$2K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
14 |
13 |
$554.19 |
| V2760 |
Scratch resistant coating, per lens |
207 |
206 |
$410.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
15 |
15 |
$190.00 |
| S9999 |
Sales tax |
14 |
14 |
$34.32 |