| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
13,401 |
12,834 |
$1.61M |
| 92014 |
|
15,688 |
14,944 |
$1.49M |
| V2020 |
Vision svcs frames purchases |
29,170 |
27,090 |
$1.16M |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
15,930 |
14,816 |
$782K |
| 92015 |
|
31,406 |
29,908 |
$483K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
3,201 |
2,903 |
$215K |
| V2410 |
Lens variab asphericity sing |
1,391 |
1,224 |
$214K |
| V2100 |
Lens spher single plano 4.00 |
4,767 |
4,456 |
$190K |
| V2755 |
Uv lens/es |
4,418 |
4,095 |
$119K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,890 |
1,756 |
$79K |
| V2107 |
Spherocylinder 4.25d/12-2d |
1,033 |
958 |
$54K |
| V2784 |
Lens polycarb or equal |
1,286 |
902 |
$54K |
| V2200 |
Lens spher bifoc plano 4.00d |
483 |
457 |
$30K |
| 92002 |
|
704 |
681 |
$13K |
| 92012 |
|
482 |
456 |
$12K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
28 |
27 |
$1K |
| 92310 |
|
69 |
67 |
$783.00 |
| V2750 |
Anti-reflective coating |
50 |
47 |
$140.00 |