| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
7,250 |
6,814 |
$503K |
| 92004 |
|
5,654 |
5,338 |
$477K |
| V2020 |
Vision svcs frames purchases |
15,685 |
14,674 |
$247K |
| 99211 |
|
12,064 |
11,718 |
$153K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
6,850 |
6,368 |
$144K |
| V2100 |
Lens spher single plano 4.00 |
5,158 |
4,686 |
$114K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,222 |
1,087 |
$68K |
| V2200 |
Lens spher bifoc plano 4.00d |
440 |
386 |
$25K |
| 92340 |
|
1,925 |
1,610 |
$17K |
| V2107 |
Spherocylinder 4.25d/12-2d |
244 |
240 |
$6K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
111 |
110 |
$3K |
| V2781 |
Progressive lens per lens |
26 |
25 |
$2K |
| V2799 |
Misc vision item or service |
218 |
214 |
$2K |
| 3072F |
|
1,355 |
1,313 |
$740.00 |
| V2299 |
Lens bifocal speciality |
12 |
12 |
$707.22 |
| V2025 |
Eyeglasses delux frames |
13 |
13 |
$517.80 |
| V2101 |
Single visn sphere 4.12-7.00 |
15 |
14 |
$354.68 |
| V2784 |
Lens polycarb or equal |
31 |
31 |
$137.72 |
| S0580 |
Polycarb lens |
115 |
113 |
$69.00 |
| 92015 |
|
1,312 |
982 |
$0.00 |
| V2750 |
Anti-reflective coating |
25 |
24 |
$0.00 |