| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
9,960 |
8,966 |
$191K |
| 92004 |
|
5,125 |
4,952 |
$59K |
| 92012 |
|
2,529 |
1,945 |
$47K |
| 92250 |
|
1,705 |
1,457 |
$25K |
| 92340 |
|
1,421 |
1,414 |
$23K |
| 92015 |
|
9,784 |
9,247 |
$14K |
| 66984 |
|
79 |
51 |
$13K |
| 92134 |
|
1,226 |
1,017 |
$12K |
| 92136 |
|
311 |
265 |
$5K |
| V2020 |
Vision svcs frames purchases |
4,811 |
4,778 |
$3K |
| 99214 |
|
108 |
86 |
$2K |
| 99204 |
|
66 |
54 |
$2K |
| V2100 |
Lens spher single plano 4.00 |
5,826 |
2,960 |
$2K |
| 67028 |
|
37 |
26 |
$2K |
| 92133 |
|
161 |
145 |
$1K |
| 99213 |
|
36 |
35 |
$1K |
| 92025 |
|
145 |
122 |
$1K |
| V2784 |
Lens polycarb or equal |
5,698 |
2,872 |
$972.42 |
| 92341 |
|
42 |
42 |
$580.00 |
| 92020 |
|
112 |
92 |
$474.47 |
| 92083 |
|
27 |
24 |
$454.92 |
| 92202 |
|
167 |
121 |
$396.40 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,062 |
546 |
$367.50 |
| V2200 |
Lens spher bifoc plano 4.00d |
182 |
99 |
$338.00 |
| 92201 |
|
63 |
37 |
$175.94 |
| 76514 |
|
33 |
25 |
$55.34 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
24 |
13 |
$39.00 |
| G9903 |
Pt scrn tbco id as non user |
2,807 |
2,376 |
$0.00 |
| 2023F |
|
298 |
298 |
$0.00 |
| 1036F |
|
2,822 |
2,382 |
$0.00 |
| G8428 |
Cur meds not document |
1,989 |
1,674 |
$0.00 |
| V2781 |
Progressive lens per lens |
146 |
72 |
$0.00 |
| 2033F |
|
22 |
22 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
102 |
51 |
$0.00 |
| V2299 |
Lens bifocal speciality |
122 |
60 |
$0.00 |
| G8397 |
Dil macula/fundus exam/w doc |
27 |
12 |
$0.00 |
| V2750 |
Anti-reflective coating |
3,198 |
1,591 |
$0.00 |
| 2022F |
|
170 |
127 |
$0.00 |
| 0517F |
|
225 |
195 |
$0.00 |
| G8427 |
Docrev cur meds by elig clin |
713 |
626 |
$0.00 |
| 2026F |
|
137 |
115 |
$0.00 |
| 2024F |
|
83 |
51 |
$0.00 |
| G9744 |
Pt not eli d/t act dig htn |
52 |
30 |
$0.00 |
| 2021F |
|
24 |
12 |
$0.00 |
| 5010F |
|
27 |
12 |
$0.00 |