| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
6,428 |
6,176 |
$42K |
| 92014 |
|
5,008 |
4,673 |
$40K |
| V2100 |
Lens spher single plano 4.00 |
17,501 |
9,545 |
$32K |
| 92340 |
|
2,220 |
2,000 |
$32K |
| V2020 |
Vision svcs frames purchases |
11,819 |
11,128 |
$21K |
| 92015 |
|
2,085 |
1,803 |
$6K |
| V2200 |
Lens spher bifoc plano 4.00d |
1,204 |
740 |
$6K |
| V2784 |
Lens polycarb or equal |
7,168 |
3,669 |
$4K |
| 92310 |
|
641 |
597 |
$3K |
| 92341 |
|
208 |
191 |
$3K |
| 92250 |
|
3,681 |
3,463 |
$849.42 |
| V2500 |
Contact lens pmma spherical |
14 |
13 |
$420.00 |
| V2755 |
Uv lens/es |
1,327 |
638 |
$5.70 |
| S0500 |
Dispos cont lens |
123 |
117 |
$0.00 |
| V2799 |
Misc vision item or service |
253 |
198 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
268 |
147 |
$0.00 |
| V2781 |
Progressive lens per lens |
34 |
15 |
$0.00 |
| V2750 |
Anti-reflective coating |
3,415 |
1,812 |
$0.00 |
| V2797 |
Vis item/svc in other code |
131 |
120 |
$0.00 |
| 92201 |
|
272 |
223 |
$0.00 |
| S9986 |
Not medically necessary svc |
709 |
649 |
$0.00 |
| V2300 |
Lens sphere trifocal 4.00d |
50 |
25 |
$0.00 |