| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
7,417 |
5,262 |
$590K |
| 92014 |
|
8,617 |
5,377 |
$510K |
| 92081 |
|
9,514 |
6,109 |
$162K |
| 92012 |
|
3,198 |
2,155 |
$148K |
| V2020 |
Vision svcs frames purchases |
6,167 |
5,833 |
$87K |
| 92250 |
|
2,067 |
1,376 |
$78K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,526 |
3,274 |
$62K |
| V2100 |
Lens spher single plano 4.00 |
2,791 |
2,643 |
$59K |
| V2025 |
Eyeglasses delux frames |
1,869 |
1,703 |
$49K |
| V2784 |
Lens polycarb or equal |
4,851 |
4,571 |
$48K |
| 92015 |
|
16,524 |
10,964 |
$37K |
| 92340 |
|
682 |
676 |
$20K |
| S0580 |
Polycarb lens |
1,676 |
1,544 |
$20K |
| 92060 |
|
885 |
313 |
$16K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
861 |
801 |
$15K |
| 92285 |
|
1,363 |
826 |
$13K |
| 83861 |
|
896 |
392 |
$8K |
| 92083 |
|
158 |
158 |
$8K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
146 |
138 |
$6K |
| V2102 |
Singl visn sphere 7.12-20.00 |
146 |
127 |
$6K |
| S0620 |
Routine ophthalmological exa |
171 |
148 |
$6K |
| 92133 |
|
139 |
139 |
$5K |
| 92002 |
|
65 |
41 |
$3K |
| S0592 |
Comp cont lens eval |
12 |
12 |
$824.00 |
| S0621 |
Routine ophthalmological exa |
12 |
12 |
$478.25 |
| 99072 |
|
559 |
520 |
$391.50 |
| V2101 |
Single visn sphere 4.12-7.00 |
15 |
13 |
$304.04 |
| V2750 |
Anti-reflective coating |
67 |
66 |
$266.58 |
| 76514 |
|
15 |
15 |
$121.58 |