| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
1,696 |
1,544 |
$102K |
| 92004 |
|
1,128 |
1,019 |
$87K |
| V2750 |
Anti-reflective coating, per lens |
762 |
709 |
$57K |
| 92340 |
|
2,629 |
2,409 |
$41K |
| 92015 |
|
3,180 |
2,880 |
$24K |
| V2020 |
Frames, purchases |
2,182 |
2,009 |
$21K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,318 |
1,217 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,291 |
1,212 |
$21K |
| V2499 |
Variable sphericity lens, other type |
201 |
195 |
$14K |
| 99213 |
|
325 |
273 |
$7K |
| 92250 |
|
41 |
37 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
43 |
40 |
$1K |
| 99214 |
|
31 |
25 |
$859.61 |
| 92342 |
|
35 |
28 |
$403.20 |