| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
|
6,611 |
6,442 |
$463K |
| 92250 |
|
10,313 |
10,010 |
$352K |
| 99204 |
|
2,425 |
2,376 |
$281K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
7,438 |
5,908 |
$249K |
| V2020 |
Vision svcs frames purchases |
11,426 |
11,105 |
$239K |
| 92015 |
|
6,156 |
5,948 |
$141K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
2,399 |
1,845 |
$130K |
| V2100 |
Lens spher single plano 4.00 |
3,220 |
2,680 |
$101K |
| 92340 |
|
4,925 |
4,743 |
$84K |
| S0580 |
Polycarb lens |
5,449 |
3,694 |
$68K |
| 92014 |
|
1,014 |
982 |
$37K |
| V2784 |
Lens polycarb or equal |
1,603 |
1,546 |
$32K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
864 |
742 |
$30K |
| 92341 |
|
1,508 |
1,462 |
$29K |
| 99213 |
|
588 |
450 |
$29K |
| 92004 |
|
547 |
534 |
$27K |
| V2107 |
Spherocylinder 4.25d/12-2d |
620 |
523 |
$22K |
| V2200 |
Lens spher bifoc plano 4.00d |
150 |
124 |
$7K |
| S0621 |
Routine ophthalmological exa |
136 |
136 |
$6K |
| 99212 |
|
32 |
25 |
$1K |
| S0620 |
Routine ophthalmological exa |
16 |
16 |
$1K |
| V2025 |
Eyeglasses delux frames |
12 |
12 |
$597.70 |