| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
24,253 |
23,185 |
$591K |
| V2100 |
Lens spher single plano 4.00 |
14,197 |
12,865 |
$332K |
| 92004 |
|
1,864 |
1,844 |
$176K |
| 92014 |
|
1,847 |
1,832 |
$127K |
| V2200 |
Lens spher bifoc plano 4.00d |
3,219 |
2,844 |
$103K |
| V2110 |
Spherocylinder 4.25d/over 6d |
1,683 |
1,594 |
$76K |
| 92015 |
|
4,184 |
4,146 |
$62K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,455 |
1,426 |
$37K |
| V2756 |
Eye glass case |
22,064 |
21,217 |
$23K |
| V2784 |
Lens polycarb or equal |
1,391 |
1,328 |
$21K |
| 92002 |
|
241 |
238 |
$14K |
| 92012 |
|
261 |
259 |
$13K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
336 |
318 |
$11K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
245 |
243 |
$6K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
65 |
62 |
$2K |
| V2781 |
Progressive lens per lens |
27 |
26 |
$1K |
| S0621 |
Routine ophthalmological exa |
14 |
13 |
$794.00 |
| V2205 |
Lens sphcy bifocal 4.00d/4.2 |
13 |
13 |
$443.28 |
| S0580 |
Polycarb lens |
27 |
27 |
$436.00 |