| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2799 |
Misc vision item or service |
37,339 |
37,337 |
$125K |
| V2020 |
Vision svcs frames purchases |
418,938 |
413,323 |
$498.68 |
| 92014 |
|
192,669 |
191,464 |
$426.00 |
| 92004 |
|
169,748 |
168,705 |
$365.00 |
| 92015 |
|
369,117 |
367,336 |
$209.09 |
| 92340 |
|
262,648 |
260,380 |
$140.01 |
| 92133 |
|
2,536 |
2,512 |
$136.32 |
| 92341 |
|
111,525 |
110,509 |
$63.60 |
| V2207 |
Lens sphcy bifocal 4.25-7d/. |
1,606 |
1,595 |
$32.77 |
| 92081 |
|
5,880 |
5,734 |
$29.52 |
| V2025 |
Eyeglasses delux frames |
2,680 |
2,653 |
$25.98 |
| 99213 |
|
16,856 |
15,750 |
$21.60 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
41,042 |
40,563 |
$0.00 |
| 99204 |
|
4,776 |
4,729 |
$0.00 |
| 92012 |
|
14,680 |
13,993 |
$0.00 |
| 99203 |
|
5,003 |
4,974 |
$0.00 |
| V2205 |
Lens sphcy bifocal 4.00d/4.2 |
228 |
227 |
$0.00 |
| 76514 |
|
316 |
314 |
$0.00 |
| 92083 |
|
2,275 |
2,248 |
$0.00 |
| 92134 |
|
1,329 |
1,315 |
$0.00 |
| 99212 |
|
4,147 |
3,948 |
$0.00 |
| 92352 |
|
218 |
218 |
$0.00 |
| 99215 |
Prolong outpt/office vis |
944 |
926 |
$0.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
4,487 |
4,472 |
$0.00 |
| 68761 |
|
5,709 |
1,502 |
$0.00 |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
3,581 |
3,578 |
$0.00 |
| 92020 |
|
309 |
308 |
$0.00 |
| 92225 |
|
116 |
99 |
$0.00 |
| V2410 |
Lens variab asphericity sing |
123 |
123 |
$0.00 |
| V2106 |
Spherocylinder 4.00d/>6.00d |
12 |
12 |
$0.00 |
| V2750 |
Anti-reflective coating |
16 |
16 |
$0.00 |
| V2102 |
Singl visn sphere 7.12-20.00 |
12 |
12 |
$0.00 |
| V2208 |
Lens sphcy bifocal 4.25-7/2. |
286 |
286 |
$0.00 |
| V2756 |
Eye glass case |
67 |
67 |
$0.00 |
| 99214 |
|
7,879 |
7,586 |
$0.00 |
| 92250 |
|
17,171 |
16,967 |
$0.00 |
| V2200 |
Lens spher bifoc plano 4.00d |
13,353 |
13,336 |
$0.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
48,341 |
47,856 |
$0.00 |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
1,307 |
1,302 |
$0.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
7,339 |
7,279 |
$0.00 |
| V2100 |
Lens spher single plano 4.00 |
17,514 |
17,156 |
$0.00 |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
1,199 |
1,185 |
$0.00 |
| 83861 |
|
2,911 |
2,757 |
$0.00 |
| 92283 |
|
892 |
891 |
$0.00 |
| V2784 |
Lens polycarb or equal |
1,755 |
1,739 |
$0.00 |
| V2112 |
Spherocylindr 7.25d/2.25-4d |
144 |
143 |
$0.00 |
| V2101 |
Single visn sphere 4.12-7.00 |
866 |
863 |
$0.00 |
| 92082 |
|
172 |
170 |
$0.00 |
| 99202 |
|
31 |
31 |
$0.00 |
| 92002 |
|
1,526 |
1,524 |
$0.00 |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
671 |
666 |
$0.00 |
| 92353 |
|
472 |
472 |
$0.00 |
| V2201 |
Lens sphere bifocal 4.12-7.0 |
109 |
108 |
$0.00 |
| V2715 |
Prism lens/es |
302 |
302 |
$0.00 |
| V2109 |
Spherocylinder 4.25d/4.25-6d |
138 |
137 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
132 |
132 |
$0.00 |
| 92273 |
|
109 |
70 |
$0.00 |
| V2211 |
Lens sphcy bifo 7.25-12/.25- |
100 |
97 |
$0.00 |
| 92136 |
|
12 |
12 |
$0.00 |