| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
8,653 |
8,189 |
$252K |
| V2020 |
Frames, purchases |
10,906 |
10,443 |
$234K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
8,021 |
7,801 |
$160K |
| 92004 |
|
4,821 |
4,570 |
$147K |
| 99213 |
|
2,062 |
1,458 |
$100K |
| 92012 |
|
1,232 |
1,157 |
$76K |
| 92015 |
|
6,518 |
5,986 |
$48K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,742 |
5,572 |
$47K |
| 92340 |
|
1,734 |
1,648 |
$41K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,144 |
1,110 |
$41K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
650 |
648 |
$32K |
| 92002 |
|
406 |
397 |
$24K |
| 92250 |
|
775 |
696 |
$20K |
| V2025 |
Deluxe frame |
810 |
798 |
$19K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
106 |
98 |
$12K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
230 |
225 |
$11K |
| 92310 |
|
180 |
149 |
$9K |
| 92083 |
|
262 |
190 |
$8K |
| 92341 |
|
146 |
146 |
$4K |
| 92133 |
|
169 |
109 |
$3K |
| 92134 |
|
84 |
46 |
$722.50 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
28 |
27 |
$583.68 |
| 76514 |
|
28 |
24 |
$188.39 |
| V2750 |
Anti-reflective coating, per lens |
206 |
181 |
$120.00 |
| 3072F |
|
464 |
460 |
$0.00 |