| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
6,666 |
6,295 |
$244K |
| V2020 |
Vision svcs frames purchases |
11,304 |
11,103 |
$170K |
| 92004 |
|
3,251 |
3,051 |
$119K |
| 92015 |
|
12,591 |
11,747 |
$114K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
4,387 |
4,348 |
$70K |
| V2100 |
Lens spher single plano 4.00 |
1,626 |
1,145 |
$56K |
| V2784 |
Lens polycarb or equal |
7,327 |
7,047 |
$51K |
| 92012 |
|
815 |
778 |
$26K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
921 |
912 |
$23K |
| 92250 |
|
745 |
717 |
$21K |
| 92083 |
|
667 |
639 |
$14K |
| 99214 |
|
169 |
167 |
$10K |
| S0621 |
Routine ophthalmological exa |
306 |
304 |
$9K |
| S0580 |
Polycarb lens |
268 |
268 |
$8K |
| 99204 |
|
83 |
81 |
$7K |
| 92341 |
|
296 |
256 |
$6K |
| V2025 |
Eyeglasses delux frames |
71 |
71 |
$5K |
| 99213 |
|
121 |
94 |
$3K |
| 92340 |
|
177 |
177 |
$2K |
| 92133 |
|
167 |
157 |
$2K |
| V2200 |
Lens spher bifoc plano 4.00d |
16 |
16 |
$1K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
76 |
75 |
$761.76 |
| S0620 |
Routine ophthalmological exa |
24 |
24 |
$720.00 |
| 92020 |
|
32 |
26 |
$260.75 |
| 92132 |
|
44 |
43 |
$239.77 |
| V2107 |
Spherocylinder 4.25d/12-2d |
12 |
12 |
$133.00 |
| V2750 |
Anti-reflective coating |
16 |
16 |
$0.00 |
| S9986 |
Not medically necessary svc |
19 |
19 |
$0.00 |
| V2799 |
Misc vision item or service |
26 |
24 |
$0.00 |