| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
3,865 |
3,300 |
$169K |
| 92340 |
|
3,761 |
3,144 |
$110K |
| 92015 |
|
5,703 |
4,981 |
$102K |
| 92004 |
|
1,831 |
1,651 |
$85K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,004 |
2,414 |
$43K |
| V2020 |
Frames, purchases |
4,626 |
3,949 |
$41K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,812 |
2,310 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,060 |
985 |
$11K |
| 92341 |
|
208 |
154 |
$6K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
15 |
15 |
$493.00 |
| 99214 |
|
15 |
15 |
$461.75 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
12 |
$99.00 |