| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99203 |
|
1,023 |
1,013 |
$56K |
| 92004 |
|
3,189 |
3,176 |
$38K |
| 92014 |
|
2,567 |
2,542 |
$13K |
| V2020 |
Vision svcs frames purchases |
10,253 |
10,191 |
$11K |
| V2100 |
Lens spher single plano 4.00 |
6,718 |
5,637 |
$7K |
| 92250 |
|
565 |
556 |
$6K |
| 92015 |
|
2,596 |
2,587 |
$4K |
| V2200 |
Lens spher bifoc plano 4.00d |
3,162 |
2,563 |
$4K |
| 76512 |
|
181 |
118 |
$2K |
| 92012 |
|
499 |
496 |
$93.00 |
| 68761 |
|
19 |
12 |
$45.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,227 |
671 |
$10.50 |
| 3072F |
|
800 |
795 |
$0.00 |
| V2299 |
Lens bifocal speciality |
283 |
267 |
$0.00 |
| V2781 |
Progressive lens per lens |
271 |
260 |
$0.00 |
| G9903 |
Pt scrn tbco id as non user |
45 |
45 |
$0.00 |
| V2745 |
Tint, any color/solid/grad |
184 |
114 |
$0.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
867 |
483 |
$0.00 |