| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological exa |
4,036 |
3,906 |
$172K |
| V2025 |
Eyeglasses delux frames |
1,919 |
1,866 |
$87K |
| V2020 |
Vision svcs frames purchases |
4,699 |
4,464 |
$77K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,717 |
3,580 |
$71K |
| S0620 |
Routine ophthalmological exa |
1,444 |
1,395 |
$60K |
| V2784 |
Lens polycarb or equal |
1,415 |
1,363 |
$43K |
| V2744 |
Tint photochromatic lens/es |
412 |
408 |
$19K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,138 |
1,088 |
$19K |
| V2100 |
Lens spher single plano 4.00 |
217 |
211 |
$3K |
| V2107 |
Spherocylinder 4.25d/12-2d |
119 |
115 |
$2K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
69 |
57 |
$2K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
54 |
53 |
$2K |
| 92014 |
|
15 |
15 |
$675.00 |