| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
34,485 |
34,390 |
$1.31M |
| 92014 |
|
14,740 |
14,715 |
$1.05M |
| 92004 |
|
11,250 |
11,226 |
$959K |
| 92340 |
|
27,962 |
27,871 |
$641K |
| 92015 |
|
30,466 |
30,353 |
$341K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
20,890 |
20,822 |
$296K |
| 92341 |
|
7,258 |
7,240 |
$186K |
| 99214 |
|
2,394 |
2,376 |
$157K |
| 99213 |
|
3,382 |
3,117 |
$152K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
5,999 |
5,990 |
$87K |
| 92250 |
|
3,112 |
3,099 |
$79K |
| S0621 |
Routine ophthalmological exa |
1,390 |
1,390 |
$68K |
| V2100 |
Lens spher single plano 4.00 |
5,850 |
5,833 |
$63K |
| S0620 |
Routine ophthalmological exa |
866 |
863 |
$41K |
| 99212 |
|
1,168 |
1,056 |
$32K |
| 92060 |
|
834 |
827 |
$30K |
| 99204 |
|
242 |
242 |
$22K |
| V2107 |
Spherocylinder 4.25d/12-2d |
1,686 |
1,681 |
$22K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,562 |
1,554 |
$21K |
| 92133 |
|
876 |
870 |
$18K |
| 99406 |
|
1,842 |
1,836 |
$16K |
| 92012 |
|
334 |
332 |
$16K |
| 92083 |
|
402 |
399 |
$14K |
| V2200 |
Lens spher bifoc plano 4.00d |
1,291 |
1,286 |
$13K |
| 92002 |
|
138 |
138 |
$6K |
| 92285 |
|
335 |
329 |
$4K |
| V2101 |
Single visn sphere 4.12-7.00 |
344 |
342 |
$4K |
| 99203 |
|
49 |
49 |
$3K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
175 |
174 |
$2K |
| V2207 |
Lens sphcy bifocal 4.25-7d/. |
102 |
102 |
$2K |
| 92342 |
|
51 |
51 |
$1K |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
87 |
87 |
$912.38 |
| V2799 |
Misc vision item or service |
94 |
94 |
$860.30 |
| 92134 |
|
38 |
38 |
$853.06 |
| V2715 |
Prism lens/es |
119 |
119 |
$852.12 |
| 99211 |
|
26 |
26 |
$314.08 |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
12 |
12 |
$224.07 |
| 2022F |
|
762 |
758 |
$0.00 |
| 2025F |
|
14 |
14 |
$0.00 |
| V2756 |
Eye glass case |
225 |
225 |
$0.00 |
| 2023F |
|
246 |
246 |
$0.00 |
| 3072F |
|
70 |
70 |
$0.00 |