| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
1,451 |
1,331 |
$97K |
| 92004 |
|
967 |
920 |
$80K |
| V2020 |
Frames, purchases |
2,620 |
2,366 |
$37K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,486 |
1,354 |
$25K |
| 99211 |
|
1,934 |
1,795 |
$23K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
134 |
109 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
361 |
350 |
$6K |
| 92015 |
|
988 |
906 |
$0.00 |
| 99072 |
|
306 |
279 |
$0.00 |