| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
104 |
104 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
20 |
20 |
$2K |
| 92012 |
Ophthalmological services: medical examination and evaluation, intermediate, established patient |
39 |
38 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
18 |
18 |
$594.00 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
33 |
33 |
$311.94 |
| S0516 |
Safety eyeglass frames |
19 |
19 |
$303.62 |
| V2020 |
Frames, purchases |
38 |
19 |
$142.50 |
| S9999 |
Sales tax |
33 |
33 |
$56.04 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
34 |
17 |
$51.00 |
| 92015 |
Determination of refractive state |
129 |
129 |
$40.44 |