| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
494 |
488 |
$35K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
275 |
268 |
$26K |
| V2020 |
Frames, purchases |
729 |
615 |
$14K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
297 |
294 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
330 |
323 |
$9K |
| S0516 |
Safety eyeglass frames |
839 |
838 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
451 |
415 |
$5K |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
851 |
850 |
$3K |
| 92015 |
Determination of refractive state |
906 |
880 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
38 |
29 |
$545.33 |
| 92370 |
|
15 |
15 |
$456.75 |
| S9999 |
Sales tax |
45 |
45 |
$72.42 |