| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,748 |
1,696 |
$117K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,132 |
1,109 |
$99K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,971 |
1,922 |
$58K |
| V2020 |
Frames, purchases |
2,780 |
2,363 |
$57K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,954 |
1,698 |
$33K |
| 92015 |
Determination of refractive state |
3,109 |
3,025 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,469 |
1,201 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
82 |
76 |
$1K |
| S0516 |
Safety eyeglass frames |
12 |
12 |
$191.76 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
12 |
12 |
$110.10 |
| S9999 |
Sales tax |
56 |
55 |
$103.26 |