| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
461 |
456 |
$32K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
190 |
187 |
$18K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
520 |
517 |
$17K |
| V2020 |
Frames, purchases |
1,048 |
813 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
364 |
336 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
651 |
508 |
$4K |
| 99214 |
Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity |
62 |
56 |
$3K |
| 92015 |
Determination of refractive state |
170 |
162 |
$2K |
| S0516 |
Safety eyeglass frames |
63 |
62 |
$990.76 |
| V2760 |
Scratch resistant coating, per lens |
331 |
327 |
$652.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
31 |
31 |
$559.40 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
63 |
62 |
$558.98 |
| 92370 |
|
17 |
17 |
$465.45 |
| 92341 |
|
12 |
12 |
$456.00 |
| S9999 |
Sales tax |
92 |
91 |
$189.51 |