| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
4,093 |
3,945 |
$119K |
| V2020 |
Frames, purchases |
5,087 |
4,905 |
$96K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,470 |
2,408 |
$91K |
| 92015 |
|
5,196 |
5,047 |
$62K |
| 92004 |
|
1,698 |
1,592 |
$52K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,718 |
4,575 |
$48K |
| 92340 |
|
1,589 |
1,565 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
309 |
306 |
$12K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
185 |
182 |
$10K |
| 92310 |
|
82 |
80 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
82 |
78 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
68 |
66 |
$3K |
| 92250 |
|
83 |
80 |
$2K |
| 92341 |
|
123 |
115 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
87 |
85 |
$1K |
| 99213 |
|
14 |
14 |
$436.10 |
| V2025 |
Deluxe frame |
83 |
80 |
$0.00 |