| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
|
2,179 |
1,934 |
$39K |
| 92250 |
|
1,241 |
1,233 |
$36K |
| 92004 |
|
3,672 |
3,652 |
$5K |
| 92014 |
|
5,611 |
5,581 |
$4K |
| 92133 |
|
123 |
121 |
$3K |
| 92083 |
|
142 |
142 |
$2K |
| 92015 |
|
6,354 |
6,273 |
$1K |
| V2020 |
Vision svcs frames purchases |
8,029 |
7,945 |
$928.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,792 |
1,292 |
$476.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
489 |
370 |
$393.50 |
| V2784 |
Lens polycarb or equal |
5,552 |
3,640 |
$230.00 |
| 92020 |
|
14 |
14 |
$192.00 |
| V2100 |
Lens spher single plano 4.00 |
7,681 |
5,112 |
$150.80 |
| V2200 |
Lens spher bifoc plano 4.00d |
671 |
496 |
$24.00 |
| V2750 |
Anti-reflective coating |
2,186 |
1,254 |
$0.00 |
| 2022F |
|
59 |
50 |
$0.00 |
| S0621 |
Routine ophthalmological exa |
124 |
124 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
700 |
407 |
$0.00 |
| V2781 |
Progressive lens per lens |
195 |
123 |
$0.00 |
| V2299 |
Lens bifocal speciality |
160 |
106 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
114 |
114 |
$0.00 |