| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,031 |
2,031 |
$22K |
| 99214 |
|
336 |
324 |
$13K |
| 92004 |
|
560 |
560 |
$8K |
| 92340 |
|
440 |
439 |
$8K |
| 92015 |
|
538 |
538 |
$2K |
| V2020 |
Vision svcs frames purchases |
2,311 |
2,291 |
$980.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,884 |
1,044 |
$630.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
882 |
485 |
$338.00 |
| V2784 |
Lens polycarb or equal |
1,968 |
1,068 |
$332.50 |
| V2100 |
Lens spher single plano 4.00 |
609 |
353 |
$189.00 |
| S0621 |
Routine ophthalmological exa |
228 |
228 |
$0.00 |
| V2781 |
Progressive lens per lens |
287 |
146 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
191 |
97 |
$0.00 |
| V2599 |
Contact lens/es other type |
12 |
12 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
30 |
30 |
$0.00 |