| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Lens spher single plano 4.00 |
15,149 |
12,650 |
$714K |
| 92012 |
|
10,809 |
9,412 |
$486K |
| 92004 |
|
9,322 |
8,597 |
$411K |
| V2020 |
Vision svcs frames purchases |
17,110 |
14,508 |
$262K |
| 92340 |
|
7,979 |
7,491 |
$222K |
| 92015 |
|
12,175 |
11,347 |
$175K |
| V2025 |
Eyeglasses delux frames |
4,870 |
4,514 |
$174K |
| 92014 |
|
4,046 |
3,746 |
$171K |
| V2200 |
Lens spher bifoc plano 4.00d |
2,220 |
1,922 |
$157K |
| S0621 |
Routine ophthalmological exa |
1,069 |
1,061 |
$48K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,564 |
3,339 |
$45K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,094 |
1,016 |
$13K |
| S0620 |
Routine ophthalmological exa |
188 |
187 |
$9K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
344 |
310 |
$7K |
| V2784 |
Lens polycarb or equal |
421 |
410 |
$4K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
147 |
142 |
$2K |
| V2107 |
Spherocylinder 4.25d/12-2d |
126 |
121 |
$1K |
| V2760 |
Scratch resistant coating |
69 |
28 |
$0.00 |