| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
5,609 |
4,822 |
$58K |
| 92014 |
|
5,491 |
4,689 |
$27K |
| V2020 |
Vision svcs frames purchases |
4,785 |
3,931 |
$11K |
| V2025 |
Eyeglasses delux frames |
480 |
466 |
$185.57 |
| 92015 |
|
12,999 |
11,126 |
$15.77 |
| S3000 |
Bilat dil retinal exam |
127 |
78 |
$9.24 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
140 |
60 |
$0.77 |
| 2022F |
|
7,552 |
6,187 |
$0.00 |
| G0117 |
Glaucoma scrn hgh risk direc |
7,687 |
6,363 |
$0.00 |
| V2750 |
Anti-reflective coating |
331 |
239 |
$0.00 |
| 92340 |
|
1,239 |
1,132 |
$0.00 |
| 92341 |
|
593 |
573 |
$0.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
281 |
126 |
$0.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
40 |
12 |
$0.00 |
| V2745 |
Tint, any color/solid/grad |
44 |
27 |
$0.00 |
| V2100 |
Lens spher single plano 4.00 |
1,695 |
1,274 |
$0.00 |
| 92342 |
|
1,433 |
1,251 |
$0.00 |
| 3072F |
|
688 |
575 |
$0.00 |
| V2756 |
Eye glass case |
1,368 |
1,186 |
$0.00 |
| V2781 |
Progressive lens per lens |
13 |
13 |
$0.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,792 |
729 |
$0.00 |
| 2023F |
|
130 |
128 |
$0.00 |
| 2019F |
|
871 |
704 |
$0.00 |
| V2784 |
Lens polycarb or equal |
266 |
255 |
$0.00 |
| V2200 |
Lens spher bifoc plano 4.00d |
387 |
367 |
$0.00 |
| V2799 |
Misc vision item or service |
46 |
44 |
$0.00 |
| 92227 |
|
16 |
16 |
$0.00 |
| 92310 |
|
38 |
25 |
$0.00 |