| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,015 |
3,469 |
$81K |
| V2020 |
Frames, purchases |
4,682 |
4,112 |
$74K |
| 92014 |
|
1,742 |
1,695 |
$63K |
| 99213 |
|
1,233 |
1,168 |
$53K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,035 |
2,511 |
$31K |
| 92004 |
|
798 |
785 |
$27K |
| 99203 |
|
457 |
456 |
$26K |
| 92310 |
|
350 |
344 |
$19K |
| 99214 |
|
259 |
252 |
$16K |
| 92250 |
|
364 |
356 |
$10K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
203 |
198 |
$6K |
| 92015 |
|
181 |
177 |
$3K |
| 92340 |
|
44 |
43 |
$799.26 |
| 92341 |
|
24 |
24 |
$571.34 |
| V2750 |
Anti-reflective coating, per lens |
12 |
12 |
$0.00 |