| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
5,083 |
4,875 |
$373K |
| 92004 |
|
2,676 |
2,592 |
$254K |
| V2100 |
Lens spher single plano 4.00 |
8,532 |
6,339 |
$238K |
| V2025 |
Eyeglasses delux frames |
5,250 |
5,052 |
$185K |
| V2020 |
Vision svcs frames purchases |
6,350 |
5,988 |
$172K |
| S0621 |
Routine ophthalmological exa |
2,395 |
2,330 |
$135K |
| S0620 |
Routine ophthalmological exa |
2,070 |
2,035 |
$119K |
| 92015 |
|
7,696 |
7,428 |
$99K |
| V2750 |
Anti-reflective coating |
1,491 |
1,414 |
$75K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
1,428 |
1,351 |
$65K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,610 |
1,191 |
$33K |
| V2784 |
Lens polycarb or equal |
861 |
811 |
$12K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
561 |
451 |
$12K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
400 |
326 |
$10K |
| V2760 |
Scratch resistant coating |
372 |
353 |
$8K |
| V2107 |
Spherocylinder 4.25d/12-2d |
338 |
266 |
$7K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
103 |
93 |
$4K |
| 92012 |
|
54 |
53 |
$3K |
| 92060 |
|
67 |
65 |
$3K |
| V2200 |
Lens spher bifoc plano 4.00d |
41 |
36 |
$2K |
| 99214 |
|
18 |
16 |
$892.45 |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
20 |
16 |
$410.06 |
| 99213 |
|
14 |
12 |
$367.53 |
| 1036F |
|
1,595 |
1,512 |
$0.00 |
| G9905 |
No pt tbco scrn rng |
1,798 |
1,674 |
$0.00 |
| V2745 |
Tint, any color/solid/grad |
30 |
27 |
$0.00 |
| G8785 |
Bp scrn no perf at interval |
14 |
14 |
$0.00 |