| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
4,649 |
3,772 |
$250K |
| V2020 |
Vision svcs frames purchases |
5,220 |
4,844 |
$80K |
| 92004 |
|
1,564 |
1,423 |
$79K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,807 |
2,633 |
$54K |
| S0621 |
Routine ophthalmological exa |
1,701 |
1,605 |
$52K |
| 92083 |
|
1,193 |
909 |
$43K |
| S0620 |
Routine ophthalmological exa |
1,405 |
1,350 |
$39K |
| 92250 |
|
972 |
829 |
$30K |
| V2784 |
Lens polycarb or equal |
2,353 |
2,139 |
$27K |
| V2100 |
Lens spher single plano 4.00 |
1,231 |
1,124 |
$22K |
| 99204 |
|
269 |
256 |
$17K |
| 92310 |
|
300 |
266 |
$16K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
521 |
501 |
$16K |
| 92015 |
|
1,043 |
965 |
$13K |
| V2200 |
Lens spher bifoc plano 4.00d |
441 |
417 |
$12K |
| 92133 |
|
560 |
471 |
$11K |
| 92340 |
|
503 |
493 |
$9K |
| V2025 |
Eyeglasses delux frames |
367 |
359 |
$7K |
| 99214 |
|
180 |
111 |
$7K |
| V2521 |
Cntct lens hydrophilic toric |
47 |
44 |
$5K |
| V2520 |
Contact lens hydrophilic |
44 |
43 |
$5K |
| 92134 |
|
217 |
185 |
$4K |
| 76514 |
|
624 |
554 |
$3K |
| 99213 |
|
46 |
27 |
$1K |
| V2781 |
Progressive lens per lens |
18 |
13 |
$825.00 |
| V2299 |
Lens bifocal speciality |
18 |
13 |
$565.50 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
15 |
15 |
$273.68 |
| 92341 |
|
14 |
14 |
$221.97 |
| 2023F |
|
95 |
83 |
$0.00 |
| 3072F |
|
65 |
59 |
$0.00 |
| 2022F |
|
309 |
260 |
$0.00 |