| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Lens spher single plano 4.00 |
17,051 |
11,869 |
$1.06M |
| 92014 |
|
10,296 |
10,055 |
$415K |
| V2020 |
Vision svcs frames purchases |
14,691 |
13,230 |
$328K |
| 92004 |
|
3,874 |
3,817 |
$159K |
| V2200 |
Lens spher bifoc plano 4.00d |
1,538 |
1,266 |
$100K |
| 92012 |
|
1,854 |
1,852 |
$74K |
| V2500 |
Contact lens pmma spherical |
231 |
231 |
$22K |
| V2750 |
Anti-reflective coating |
2,377 |
1,739 |
$20K |
| V2744 |
Tint photochromatic lens/es |
1,195 |
887 |
$18K |
| V2025 |
Eyeglasses delux frames |
1,132 |
1,102 |
$13K |
| V2299 |
Lens bifocal speciality |
231 |
170 |
$13K |
| V2784 |
Lens polycarb or equal |
5,995 |
2,307 |
$10K |
| 92015 |
|
816 |
811 |
$8K |
| V2599 |
Contact lens/es other type |
65 |
65 |
$7K |
| V2781 |
Progressive lens per lens |
426 |
320 |
$6K |
| S0621 |
Routine ophthalmological exa |
160 |
160 |
$5K |
| 92340 |
|
318 |
265 |
$3K |
| S0620 |
Routine ophthalmological exa |
80 |
80 |
$2K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
50 |
49 |
$1K |
| 99213 |
|
28 |
27 |
$954.00 |
| V2760 |
Scratch resistant coating |
49 |
28 |
$265.00 |
| V2799 |
Misc vision item or service |
26 |
26 |
$205.00 |