| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
9,648 |
9,626 |
$578K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,927 |
3,917 |
$318K |
| 92004 |
|
2,579 |
2,578 |
$298K |
| V2100 |
Lens spher single plano 4.00 |
2,671 |
2,661 |
$247K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,514 |
1,513 |
$182K |
| 92014 |
|
1,335 |
1,330 |
$110K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,114 |
1,111 |
$105K |
| V2200 |
Lens spher bifoc plano 4.00d |
898 |
894 |
$104K |
| V2219 |
Lens bifocal seg width over |
685 |
684 |
$70K |
| S0580 |
Polycarb lens |
2,800 |
2,792 |
$54K |
| V2107 |
Spherocylinder 4.25d/12-2d |
437 |
435 |
$44K |
| 92015 |
|
2,817 |
2,779 |
$35K |
| 92012 |
|
634 |
561 |
$34K |
| 92202 |
|
2,111 |
2,107 |
$21K |
| 92201 |
|
673 |
673 |
$13K |
| 92250 |
|
346 |
346 |
$10K |
| 92020 |
|
387 |
386 |
$10K |
| 92225 |
|
197 |
114 |
$6K |
| V2101 |
Single visn sphere 4.12-7.00 |
55 |
55 |
$5K |
| 92025 |
|
103 |
103 |
$3K |
| 92340 |
|
48 |
48 |
$2K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
16 |
16 |
$2K |
| 92134 |
|
43 |
43 |
$879.16 |
| 92226 |
|
22 |
14 |
$695.84 |
| 92133 |
|
13 |
13 |
$286.37 |
| 99072 |
|
909 |
863 |
$0.00 |