| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Lens spher single plano 4.00 |
22,638 |
11,086 |
$622K |
| V2020 |
Vision svcs frames purchases |
13,641 |
12,917 |
$556K |
| 99204 |
|
3,333 |
3,299 |
$265K |
| 99214 |
|
4,952 |
4,858 |
$248K |
| 92014 |
|
4,882 |
4,757 |
$211K |
| V2750 |
Anti-reflective coating |
10,022 |
4,485 |
$204K |
| 92004 |
|
3,332 |
3,215 |
$146K |
| 92015 |
|
14,806 |
14,520 |
$97K |
| V2744 |
Tint photochromatic lens/es |
2,745 |
1,303 |
$87K |
| 99203 |
|
1,287 |
1,273 |
$69K |
| 92250 |
|
1,183 |
1,177 |
$61K |
| V2200 |
Lens spher bifoc plano 4.00d |
1,597 |
820 |
$59K |
| V2299 |
Lens bifocal speciality |
1,351 |
671 |
$51K |
| V2781 |
Progressive lens per lens |
1,527 |
744 |
$50K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
1,666 |
775 |
$47K |
| V2784 |
Lens polycarb or equal |
19,920 |
9,530 |
$39K |
| 92083 |
|
605 |
602 |
$38K |
| 99213 |
|
786 |
742 |
$28K |
| V2760 |
Scratch resistant coating |
2,707 |
1,144 |
$27K |
| V2500 |
Contact lens pmma spherical |
182 |
168 |
$14K |
| V2501 |
Cntct lens pmma-toric/prism |
84 |
82 |
$7K |
| 92310 |
|
54 |
54 |
$3K |
| 92020 |
|
141 |
141 |
$2K |
| S0620 |
Routine ophthalmological exa |
36 |
35 |
$1K |
| 2022F |
|
904 |
886 |
$0.00 |