| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
649 |
606 |
$38K |
| 92004 |
|
354 |
327 |
$26K |
| V2020 |
Vision svcs frames purchases |
861 |
794 |
$23K |
| 92340 |
|
849 |
789 |
$20K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
624 |
580 |
$11K |
| V2784 |
Lens polycarb or equal |
644 |
596 |
$4K |
| V2760 |
Scratch resistant coating |
708 |
653 |
$1K |
| V2100 |
Lens spher single plano 4.00 |
48 |
45 |
$726.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
13 |
12 |
$499.25 |
| 92015 |
|
55 |
52 |
$20.00 |
| G9905 |
No pt tbco scrn rng |
298 |
280 |
$0.00 |
| G8427 |
Docrev cur meds by elig clin |
887 |
830 |
$0.00 |
| G8785 |
Bp scrn no perf at interval |
97 |
95 |
$0.00 |
| 1036F |
|
949 |
891 |
$0.00 |
| G9903 |
Pt scrn tbco id as non user |
479 |
449 |
$0.00 |
| G9902 |
Pt scrn tbco and id as user |
24 |
20 |
$0.00 |