| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
10,703 |
10,438 |
$944K |
| 92004 |
|
5,213 |
5,115 |
$557K |
| V2020 |
Vision svcs frames purchases |
13,794 |
13,475 |
$232K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
9,853 |
9,697 |
$194K |
| V2025 |
Eyeglasses delux frames |
4,865 |
4,849 |
$149K |
| V2784 |
Lens polycarb or equal |
4,958 |
4,878 |
$99K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
3,224 |
3,166 |
$64K |
| V2100 |
Lens spher single plano 4.00 |
2,297 |
2,274 |
$45K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
579 |
562 |
$20K |
| V2107 |
Spherocylinder 4.25d/12-2d |
809 |
788 |
$16K |
| S0621 |
Routine ophthalmological exa |
138 |
134 |
$6K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
131 |
128 |
$3K |
| S0620 |
Routine ophthalmological exa |
54 |
54 |
$2K |
| V2750 |
Anti-reflective coating |
225 |
224 |
$2K |
| 92310 |
|
122 |
120 |
$664.00 |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
16 |
16 |
$345.10 |
| V2744 |
Tint photochromatic lens/es |
19 |
19 |
$128.03 |