| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
10,109 |
9,838 |
$248K |
| 92250 |
|
5,950 |
5,894 |
$223K |
| 92004 |
|
8,056 |
7,876 |
$199K |
| 92340 |
|
3,447 |
3,432 |
$59K |
| 92225 |
|
1,426 |
1,387 |
$58K |
| 92015 |
|
10,568 |
10,432 |
$39K |
| 92226 |
|
1,120 |
1,086 |
$36K |
| V2020 |
Vision svcs frames purchases |
14,213 |
14,005 |
$31K |
| 99203 |
|
419 |
409 |
$25K |
| 92341 |
|
1,305 |
1,302 |
$24K |
| V2100 |
Lens spher single plano 4.00 |
19,625 |
10,401 |
$22K |
| 92012 |
|
771 |
743 |
$21K |
| V2784 |
Lens polycarb or equal |
15,722 |
8,221 |
$16K |
| V2200 |
Lens spher bifoc plano 4.00d |
2,055 |
1,322 |
$12K |
| 99213 |
|
405 |
354 |
$12K |
| 92002 |
|
260 |
260 |
$5K |
| V2520 |
Contact lens hydrophilic |
125 |
125 |
$5K |
| 92133 |
|
131 |
130 |
$3K |
| 99212 |
|
93 |
91 |
$2K |
| 92020 |
|
148 |
146 |
$2K |
| 76514 |
|
96 |
96 |
$2K |
| 92134 |
|
26 |
26 |
$625.83 |
| 92083 |
|
12 |
12 |
$192.00 |
| V2750 |
Anti-reflective coating |
12,096 |
6,163 |
$0.00 |
| 2025F |
|
121 |
74 |
$0.00 |
| 2024F |
|
30 |
29 |
$0.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
28 |
14 |
$0.00 |
| S0621 |
Routine ophthalmological exa |
229 |
229 |
$0.00 |
| V2500 |
Contact lens pmma spherical |
14 |
14 |
$0.00 |
| V2781 |
Progressive lens per lens |
1,624 |
846 |
$0.00 |
| V2299 |
Lens bifocal speciality |
1,256 |
616 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
2,182 |
1,115 |
$0.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,516 |
787 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
83 |
83 |
$0.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
34 |
17 |
$0.00 |