| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
11,520 |
10,470 |
$488K |
| 92004 |
|
7,903 |
7,035 |
$345K |
| V2100 |
Lens spher single plano 4.00 |
8,215 |
7,011 |
$272K |
| 92340 |
|
9,196 |
8,284 |
$249K |
| 92015 |
|
15,096 |
13,968 |
$231K |
| V2020 |
Vision svcs frames purchases |
7,224 |
6,957 |
$170K |
| 92012 |
|
2,382 |
1,959 |
$106K |
| V2200 |
Lens spher bifoc plano 4.00d |
1,966 |
1,613 |
$103K |
| V2025 |
Eyeglasses delux frames |
5,530 |
4,409 |
$84K |
| 92341 |
|
3,103 |
2,784 |
$83K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,018 |
2,008 |
$21K |
| S0621 |
Routine ophthalmological exa |
334 |
326 |
$15K |
| S0620 |
Routine ophthalmological exa |
267 |
259 |
$12K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
408 |
393 |
$5K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
389 |
389 |
$4K |
| V2107 |
Spherocylinder 4.25d/12-2d |
13 |
13 |
$140.36 |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
14 |
14 |
$98.00 |
| 3072F |
|
144 |
144 |
$0.00 |
| 2022F |
|
143 |
143 |
$0.00 |