| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,786 |
2,612 |
$138K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
973 |
958 |
$89K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
1,735 |
1,644 |
$77K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
794 |
781 |
$53K |
| V2020 |
Frames, purchases |
2,112 |
1,640 |
$37K |
| 92002 |
|
723 |
683 |
$36K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,083 |
940 |
$21K |
| 92015 |
Determination of refractive state |
3,034 |
2,916 |
$7K |
| V2755 |
U-v lens, per lens |
439 |
412 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
761 |
547 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
59 |
54 |
$1K |
| V2760 |
Scratch resistant coating, per lens |
331 |
306 |
$610.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
15 |
13 |
$471.56 |
| S0516 |
Safety eyeglass frames |
29 |
29 |
$463.42 |
| 92370 |
|
12 |
12 |
$348.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
48 |
25 |
$268.00 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
29 |
29 |
$263.96 |
| S9999 |
Sales tax |
87 |
87 |
$178.41 |