| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
3,319 |
3,171 |
$193K |
| V2020 |
Vision svcs frames purchases |
1,470 |
1,412 |
$106K |
| 92004 |
|
1,399 |
1,356 |
$62K |
| 92340 |
|
3,877 |
3,850 |
$55K |
| V2025 |
Eyeglasses delux frames |
3,508 |
3,486 |
$40K |
| 92015 |
|
5,084 |
4,884 |
$40K |
| 92250 |
|
123 |
107 |
$3K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,233 |
2,185 |
$1K |
| 99213 |
|
14 |
14 |
$930.54 |
| V2784 |
Lens polycarb or equal |
2,965 |
2,929 |
$585.00 |
| V2750 |
Anti-reflective coating |
57 |
56 |
$2.50 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
143 |
139 |
$0.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
35 |
33 |
$0.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
565 |
559 |
$0.00 |
| V2200 |
Lens spher bifoc plano 4.00d |
21 |
21 |
$0.00 |
| V2100 |
Lens spher single plano 4.00 |
389 |
346 |
$0.00 |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
27 |
27 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
132 |
124 |
$0.00 |
| V2101 |
Single visn sphere 4.12-7.00 |
31 |
15 |
$0.00 |