| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
7,079 |
6,818 |
$272K |
| S0621 |
Routine ophthalmological exa |
2,956 |
2,873 |
$163K |
| V2410 |
Lens variab asphericity sing |
1,752 |
1,615 |
$129K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,622 |
3,527 |
$95K |
| V2784 |
Lens polycarb or equal |
1,378 |
1,253 |
$73K |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
472 |
459 |
$64K |
| S0620 |
Routine ophthalmological exa |
848 |
832 |
$44K |
| 92014 |
|
393 |
378 |
$39K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,488 |
1,403 |
$37K |
| V2100 |
Lens spher single plano 4.00 |
926 |
913 |
$22K |
| 92015 |
|
1,312 |
1,258 |
$20K |
| 92004 |
|
81 |
77 |
$10K |
| 99213 |
|
252 |
243 |
$9K |
| 92250 |
|
100 |
89 |
$6K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
322 |
296 |
$6K |
| V2025 |
Eyeglasses delux frames |
35 |
35 |
$2K |
| V2107 |
Spherocylinder 4.25d/12-2d |
147 |
125 |
$2K |
| 92083 |
|
12 |
12 |
$693.12 |
| 92133 |
|
12 |
12 |
$470.40 |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
14 |
12 |
$165.00 |