| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
4,525 |
4,472 |
$176K |
| V2020 |
Vision svcs frames purchases |
12,016 |
9,648 |
$175K |
| V2100 |
Lens spher single plano 4.00 |
7,856 |
5,673 |
$174K |
| 92004 |
|
3,716 |
3,666 |
$147K |
| V2784 |
Lens polycarb or equal |
6,774 |
4,430 |
$73K |
| 92310 |
|
1,009 |
996 |
$56K |
| V2200 |
Lens spher bifoc plano 4.00d |
1,371 |
1,344 |
$46K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
672 |
626 |
$38K |
| 92340 |
|
1,529 |
1,489 |
$30K |
| 92341 |
|
1,060 |
1,011 |
$26K |
| 92015 |
|
1,436 |
1,408 |
$21K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
980 |
881 |
$20K |
| V2799 |
Misc vision item or service |
14 |
14 |
$3K |
| V2299 |
Lens bifocal speciality |
44 |
44 |
$2K |
| V2221 |
Lenticular lens, bifocal |
13 |
13 |
$490.10 |
| V2744 |
Tint photochromatic lens/es |
219 |
215 |
$240.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
20 |
15 |
$186.08 |
| V2745 |
Tint, any color/solid/grad |
216 |
213 |
$40.40 |
| 1036F |
|
108 |
104 |
$0.00 |
| G9903 |
Pt scrn tbco id as non user |
74 |
71 |
$0.00 |
| G9902 |
Pt scrn tbco and id as user |
24 |
24 |
$0.00 |
| V2781 |
Progressive lens per lens |
44 |
44 |
$0.00 |