| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
3,004 |
2,846 |
$256K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,245 |
3,066 |
$194K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,940 |
1,846 |
$113K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
1,729 |
1,620 |
$83K |
| 99204 |
Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity |
795 |
747 |
$73K |
| 92015 |
Determination of refractive state |
6,190 |
5,821 |
$36K |
| 92250 |
|
641 |
604 |
$22K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
89 |
78 |
$3K |
| V2020 |
Frames, purchases |
648 |
346 |
$2K |
| S0516 |
Safety eyeglass frames |
81 |
81 |
$1K |
| 99203 |
Office or other outpatient visit for the evaluation and management of a new patient, low complexity |
13 |
13 |
$950.39 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
84 |
84 |
$729.80 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
365 |
194 |
$555.00 |
| 92341 |
|
12 |
12 |
$437.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
48 |
24 |
$240.00 |
| S9999 |
Sales tax |
117 |
117 |
$224.94 |