| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,814 |
2,760 |
$109K |
| 92004 |
|
1,261 |
1,228 |
$49K |
| V2020 |
Vision svcs frames purchases |
2,750 |
2,677 |
$40K |
| 92015 |
|
3,153 |
3,092 |
$29K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,005 |
1,951 |
$25K |
| V2100 |
Lens spher single plano 4.00 |
761 |
757 |
$19K |
| 92340 |
|
895 |
881 |
$18K |
| V2784 |
Lens polycarb or equal |
2,082 |
2,025 |
$15K |
| 92341 |
|
126 |
123 |
$3K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
115 |
113 |
$1K |
| 92082 |
|
56 |
56 |
$1K |
| 99214 |
|
13 |
12 |
$793.68 |
| 92133 |
|
42 |
42 |
$622.44 |
| V2200 |
Lens spher bifoc plano 4.00d |
14 |
13 |
$527.80 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
14 |
14 |
$180.00 |
| G9903 |
Pt scrn tbco id as non user |
1,372 |
1,315 |
$0.00 |
| G9902 |
Pt scrn tbco and id as user |
120 |
115 |
$0.00 |
| 1036F |
|
1,492 |
1,434 |
$0.00 |
| G8785 |
Bp scrn no perf at interval |
1,321 |
1,251 |
$0.00 |
| G8427 |
Docrev cur meds by elig clin |
1,806 |
1,725 |
$0.00 |
| 4004F |
|
115 |
113 |
$0.00 |
| S9986 |
Not medically necessary svc |
37 |
37 |
$0.00 |