| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
11,327 |
11,292 |
$284K |
| 92340 |
|
5,603 |
5,543 |
$102K |
| 99213 |
|
689 |
644 |
$27K |
| 92015 |
|
6,068 |
6,043 |
$24K |
| 92004 |
|
463 |
456 |
$19K |
| V2100 |
Lens spher single plano 4.00 |
6,397 |
3,316 |
$3K |
| 99212 |
|
129 |
124 |
$3K |
| V2200 |
Lens spher bifoc plano 4.00d |
842 |
465 |
$2K |
| V2020 |
Vision svcs frames purchases |
5,507 |
5,465 |
$2K |
| V2784 |
Lens polycarb or equal |
5,576 |
2,864 |
$2K |
| 92133 |
|
71 |
71 |
$2K |
| V2299 |
Lens bifocal speciality |
426 |
212 |
$0.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,544 |
804 |
$0.00 |
| 2023F |
|
1,617 |
1,605 |
$0.00 |
| V2799 |
Misc vision item or service |
56 |
27 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
403 |
205 |
$0.00 |
| V2781 |
Progressive lens per lens |
535 |
274 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
37 |
37 |
$0.00 |
| 3072F |
|
35 |
34 |
$0.00 |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
44 |
21 |
$0.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
24 |
12 |
$0.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
335 |
184 |
$0.00 |
| 2022F |
|
180 |
174 |
$0.00 |
| V2750 |
Anti-reflective coating |
24 |
12 |
$0.00 |
| S0621 |
Routine ophthalmological exa |
112 |
112 |
$0.00 |