| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
3,646 |
3,526 |
$241K |
| V2020 |
Frames, purchases |
4,828 |
4,079 |
$112K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,088 |
2,981 |
$87K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,805 |
1,986 |
$35K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
238 |
220 |
$21K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,185 |
904 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,399 |
2,013 |
$12K |
| 92015 |
Determination of refractive state |
3,866 |
3,710 |
$7K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
451 |
280 |
$7K |
| V2755 |
U-v lens, per lens |
1,052 |
965 |
$6K |
| 92341 |
|
224 |
220 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
103 |
92 |
$4K |
| 92370 |
|
59 |
54 |
$1K |
| 92250 |
|
34 |
30 |
$1K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
20 |
20 |
$938.40 |
| V2760 |
Scratch resistant coating, per lens |
79 |
79 |
$88.21 |
| S9999 |
Sales tax |
49 |
48 |
$70.98 |