| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological exa |
4,085 |
3,945 |
$164K |
| V2020 |
Vision svcs frames purchases |
6,762 |
6,255 |
$91K |
| S0620 |
Routine ophthalmological exa |
2,192 |
2,124 |
$89K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
4,675 |
4,398 |
$88K |
| V2025 |
Eyeglasses delux frames |
5,780 |
5,336 |
$49K |
| V2784 |
Lens polycarb or equal |
3,024 |
2,731 |
$31K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,440 |
1,298 |
$22K |
| 92012 |
|
469 |
426 |
$21K |
| V2100 |
Lens spher single plano 4.00 |
683 |
656 |
$11K |
| V2750 |
Anti-reflective coating |
213 |
201 |
$3K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
68 |
65 |
$2K |
| V2744 |
Tint photochromatic lens/es |
93 |
79 |
$2K |
| V2745 |
Tint, any color/solid/grad |
525 |
476 |
$1K |
| 92015 |
|
1,001 |
820 |
$1K |
| 92002 |
|
17 |
13 |
$821.76 |
| V2107 |
Spherocylinder 4.25d/12-2d |
49 |
46 |
$787.50 |
| V2755 |
Uv lens/es |
218 |
200 |
$757.09 |