| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,121 |
2,066 |
$140K |
| 92340 |
|
2,172 |
2,159 |
$106K |
| 92004 |
|
1,069 |
1,039 |
$95K |
| V2020 |
Frames, purchases |
1,687 |
1,652 |
$62K |
| 92341 |
|
423 |
403 |
$26K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
927 |
918 |
$19K |
| 92015 |
|
908 |
842 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,033 |
1,011 |
$9K |
| 92002 |
|
157 |
157 |
$8K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
164 |
158 |
$8K |
| 92012 |
|
161 |
159 |
$7K |
| V2760 |
Scratch resistant coating, per lens |
964 |
950 |
$3K |
| 92370 |
|
94 |
94 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
93 |
92 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
68 |
68 |
$1K |
| 99213 |
|
18 |
16 |
$596.82 |
| 3072F |
|
382 |
356 |
$0.00 |