| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
5,247 |
4,865 |
$229K |
| 92004 |
|
3,948 |
3,669 |
$180K |
| 92340 |
|
5,905 |
5,589 |
$172K |
| 92015 |
|
9,255 |
8,683 |
$164K |
| V2025 |
Eyeglasses delux frames |
5,341 |
4,830 |
$160K |
| 92341 |
|
2,263 |
2,089 |
$65K |
| V2100 |
Lens spher single plano 4.00 |
2,305 |
2,125 |
$63K |
| V2200 |
Lens spher bifoc plano 4.00d |
1,161 |
1,040 |
$45K |
| 92012 |
|
527 |
455 |
$24K |
| S0620 |
Routine ophthalmological exa |
319 |
318 |
$15K |
| S0621 |
Routine ophthalmological exa |
306 |
302 |
$14K |
| V2784 |
Lens polycarb or equal |
1,953 |
1,827 |
$13K |
| 92310 |
|
289 |
261 |
$13K |
| V2102 |
Singl visn sphere 7.12-20.00 |
557 |
513 |
$7K |
| V2101 |
Single visn sphere 4.12-7.00 |
340 |
295 |
$4K |
| V2523 |
Cntct lens hydrophil extend |
38 |
38 |
$4K |
| V2020 |
Vision svcs frames purchases |
387 |
378 |
$2K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
137 |
133 |
$388.46 |
| V2202 |
Lens sphere bifocal 7.12-20. |
14 |
13 |
$223.68 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
35 |
35 |
$18.00 |