| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
13,299 |
13,132 |
$241K |
| S0621 |
Routine ophthalmological exa |
4,436 |
4,407 |
$192K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
6,756 |
6,684 |
$130K |
| S0620 |
Routine ophthalmological exa |
1,984 |
1,974 |
$86K |
| 92012 |
|
1,428 |
1,422 |
$77K |
| V2784 |
Lens polycarb or equal |
3,404 |
3,359 |
$71K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,792 |
1,768 |
$30K |
| 92002 |
|
437 |
433 |
$25K |
| 92015 |
|
2,716 |
2,674 |
$25K |
| V2750 |
Anti-reflective coating |
1,163 |
1,146 |
$20K |
| V2100 |
Lens spher single plano 4.00 |
713 |
708 |
$14K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
118 |
116 |
$6K |
| 99212 |
|
104 |
102 |
$2K |
| V2107 |
Spherocylinder 4.25d/12-2d |
148 |
145 |
$2K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
68 |
68 |
$2K |
| V2799 |
Misc vision item or service |
65 |
65 |
$180.13 |