| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
8,554 |
7,240 |
$384K |
| V2100 |
Lens spher single plano 4.00 |
8,511 |
5,845 |
$255K |
| V2784 |
Lens polycarb or equal |
3,034 |
1,990 |
$61K |
| 92014 |
|
1,396 |
1,359 |
$57K |
| V2750 |
Anti-reflective coating |
1,246 |
929 |
$38K |
| 92004 |
|
746 |
738 |
$31K |
| V2500 |
Contact lens pmma spherical |
473 |
368 |
$31K |
| 92012 |
|
226 |
226 |
$9K |
| S0621 |
Routine ophthalmological exa |
278 |
277 |
$8K |
| 92340 |
|
208 |
206 |
$5K |
| V2520 |
Contact lens hydrophilic |
73 |
64 |
$5K |
| V2200 |
Lens spher bifoc plano 4.00d |
103 |
71 |
$4K |
| V2521 |
Cntct lens hydrophilic toric |
53 |
44 |
$3K |
| S0620 |
Routine ophthalmological exa |
79 |
79 |
$2K |
| V2744 |
Tint photochromatic lens/es |
31 |
29 |
$1K |
| 92310 |
|
12 |
12 |
$435.00 |
| V2799 |
Misc vision item or service |
1,100 |
805 |
$0.00 |