| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
2,949 |
2,854 |
$195K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,671 |
1,617 |
$128K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,935 |
1,910 |
$61K |
| V2020 |
Frames, purchases |
2,776 |
1,933 |
$22K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,128 |
816 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,164 |
877 |
$4K |
| 92370 |
|
84 |
83 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
123 |
116 |
$2K |
| S0516 |
Safety eyeglass frames |
93 |
91 |
$1K |
| 92341 |
|
38 |
38 |
$1K |
| 92015 |
Determination of refractive state |
93 |
80 |
$1K |
| V2760 |
Scratch resistant coating, per lens |
471 |
444 |
$884.00 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
93 |
91 |
$873.72 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
65 |
61 |
$855.30 |
| S9999 |
Sales tax |
217 |
214 |
$386.82 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
15 |
$30.00 |