| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
16,548 |
15,950 |
$715K |
| 92250 |
|
26,935 |
22,082 |
$321K |
| 92014 |
|
23,118 |
22,892 |
$279K |
| V2020 |
Vision svcs frames purchases |
11,008 |
10,042 |
$229K |
| 92012 |
|
25,957 |
24,090 |
$177K |
| V2100 |
Lens spher single plano 4.00 |
4,720 |
3,364 |
$124K |
| 92025 |
|
5,641 |
5,519 |
$115K |
| 92285 |
|
13,226 |
11,065 |
$113K |
| 92340 |
|
6,176 |
5,794 |
$112K |
| 92015 |
|
10,146 |
9,243 |
$89K |
| V2200 |
Lens spher bifoc plano 4.00d |
3,198 |
1,925 |
$71K |
| 92132 |
|
3,212 |
3,131 |
$65K |
| 92341 |
|
2,953 |
2,801 |
$46K |
| V2106 |
Spherocylinder 4.00d/>6.00d |
1,301 |
1,284 |
$40K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,090 |
770 |
$38K |
| V2101 |
Single visn sphere 4.12-7.00 |
1,263 |
1,200 |
$37K |
| 92134 |
|
1,270 |
1,247 |
$33K |
| 92342 |
|
813 |
797 |
$20K |
| 92002 |
|
2,654 |
2,483 |
$19K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,507 |
801 |
$18K |
| 99213 |
|
595 |
571 |
$17K |
| 92083 |
|
329 |
324 |
$16K |
| 76514 |
|
1,196 |
1,186 |
$10K |
| V2760 |
Scratch resistant coating |
2,897 |
1,671 |
$7K |
| 99212 |
|
323 |
317 |
$7K |
| 92133 |
|
152 |
151 |
$3K |
| V2206 |
Lens sphcy bifocal 4.00d/ove |
130 |
128 |
$3K |
| V2750 |
Anti-reflective coating |
2,613 |
1,273 |
$2K |
| V2784 |
Lens polycarb or equal |
336 |
260 |
$2K |
| 92225 |
|
76 |
75 |
$1K |
| 99203 |
|
36 |
36 |
$778.80 |
| S0580 |
Polycarb lens |
89 |
88 |
$695.04 |
| 92082 |
|
18 |
18 |
$638.51 |
| 92202 |
|
124 |
123 |
$66.30 |
| 92201 |
|
25 |
20 |
$37.26 |
| V2025 |
Eyeglasses delux frames |
25 |
25 |
$0.00 |
| V2781 |
Progressive lens per lens |
268 |
263 |
$0.00 |
| V2755 |
Uv lens/es |
38 |
19 |
$0.00 |