| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,191 |
2,153 |
$137K |
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
1,616 |
1,594 |
$110K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
1,005 |
983 |
$89K |
| 92015 |
Determination of refractive state |
2,642 |
2,595 |
$7K |
| V2020 |
Frames, purchases |
440 |
236 |
$2K |
| 92370 |
|
30 |
30 |
$870.00 |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
20 |
15 |
$852.60 |
| 92341 |
|
12 |
12 |
$680.00 |
| S0516 |
Safety eyeglass frames |
24 |
24 |
$383.52 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
24 |
24 |
$220.20 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
86 |
43 |
$138.00 |
| S9999 |
Sales tax |
56 |
56 |
$97.53 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
16 |
15 |
$30.00 |