| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,353 |
2,264 |
$173K |
| 92004 |
|
1,075 |
1,056 |
$85K |
| V2020 |
Frames, purchases |
594 |
590 |
$36K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
803 |
799 |
$26K |
| V2025 |
Deluxe frame |
482 |
482 |
$25K |
| 99213 |
|
287 |
257 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
191 |
191 |
$11K |
| 92015 |
|
1,154 |
1,115 |
$6K |
| 92133 |
|
74 |
69 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
167 |
164 |
$924.75 |
| V2750 |
Anti-reflective coating, per lens |
27 |
27 |
$146.26 |
| V2755 |
U-v lens, per lens |
12 |
12 |
$7.77 |