| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
6,099 |
5,812 |
$256K |
| V2100 |
Lens spher single plano 4.00 |
3,425 |
3,020 |
$158K |
| 92004 |
|
2,754 |
2,689 |
$116K |
| V2200 |
Lens spher bifoc plano 4.00d |
904 |
752 |
$102K |
| V2020 |
Vision svcs frames purchases |
3,043 |
2,976 |
$101K |
| 92015 |
|
6,525 |
6,400 |
$83K |
| 92012 |
|
1,358 |
1,109 |
$61K |
| V2025 |
Eyeglasses delux frames |
2,416 |
2,041 |
$53K |
| 92340 |
|
1,715 |
1,677 |
$47K |
| V2784 |
Lens polycarb or equal |
2,624 |
2,618 |
$29K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,566 |
1,564 |
$16K |
| S0621 |
Routine ophthalmological exa |
181 |
179 |
$8K |
| 92341 |
|
184 |
176 |
$5K |
| S0620 |
Routine ophthalmological exa |
29 |
29 |
$1K |
| 99212 |
|
55 |
44 |
$1K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
71 |
71 |
$612.48 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
12 |
12 |
$261.03 |
| V2107 |
Spherocylinder 4.25d/12-2d |
12 |
12 |
$114.84 |
| M2025 |
|
185 |
183 |
$0.00 |
| S0581 |
Nonstnd lens |
54 |
54 |
$0.00 |