| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,314 |
1,166 |
$108K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,422 |
1,267 |
$87K |
| V2020 |
Frames, purchases |
2,229 |
1,815 |
$64K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,634 |
1,466 |
$38K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,214 |
1,039 |
$20K |
| 92015 |
Determination of refractive state |
2,602 |
2,376 |
$11K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,129 |
954 |
$7K |
| 92250 |
|
147 |
129 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
130 |
112 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
273 |
241 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
80 |
71 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
985 |
859 |
$2K |
| 92341 |
|
118 |
114 |
$2K |
| 99212 |
Office or other outpatient visit for the evaluation and management of an established patient, straightforward |
14 |
12 |
$341.88 |
| 92310 |
|
12 |
12 |
$220.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
14 |
12 |
$186.75 |
| S9999 |
Sales tax |
54 |
54 |
$125.13 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
12 |
12 |
$110.10 |