| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
1,369 |
1,366 |
$97K |
| 92014 |
|
1,124 |
1,124 |
$69K |
| V2020 |
Frames, purchases |
1,183 |
1,161 |
$50K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
763 |
757 |
$45K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
619 |
612 |
$35K |
| 99213 |
|
198 |
196 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
126 |
125 |
$7K |
| 99214 |
|
14 |
13 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
14 |
13 |
$783.90 |
| 92012 |
|
12 |
12 |
$719.16 |
| 92015 |
|
49 |
49 |
$464.63 |