| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
971 |
937 |
$87K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
847 |
826 |
$57K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,228 |
1,186 |
$35K |
| V2020 |
Frames, purchases |
1,894 |
1,635 |
$34K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,441 |
1,349 |
$24K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,422 |
1,217 |
$9K |
| 92015 |
Determination of refractive state |
1,697 |
1,635 |
$8K |
| V2750 |
Anti-reflective coating, per lens |
227 |
224 |
$4K |
| V2760 |
Scratch resistant coating, per lens |
624 |
584 |
$1K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
22 |
19 |
$809.97 |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
14 |
13 |
$509.70 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
44 |
44 |
$423.44 |
| S0516 |
Safety eyeglass frames |
14 |
14 |
$223.72 |
| S9999 |
Sales tax |
89 |
89 |
$144.90 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
13 |
$132.00 |
| 2023F |
|
220 |
218 |
$0.00 |