| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
2,636 |
2,634 |
$105K |
| V2020 |
Vision svcs frames purchases |
6,343 |
6,252 |
$80K |
| 92014 |
|
1,477 |
1,473 |
$57K |
| V2199 |
Lens single vision not oth c |
3,618 |
1,807 |
$57K |
| V2100 |
Lens spher single plano 4.00 |
2,667 |
1,366 |
$53K |
| 92340 |
|
1,103 |
1,064 |
$19K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
787 |
500 |
$12K |
| V2299 |
Lens bifocal speciality |
204 |
102 |
$6K |
| 92015 |
|
1,478 |
1,476 |
$4K |
| 92341 |
|
126 |
116 |
$2K |
| 92250 |
|
56 |
55 |
$2K |
| 99214 |
|
27 |
27 |
$2K |
| 99204 |
|
12 |
12 |
$2K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
68 |
50 |
$1K |
| V2200 |
Lens spher bifoc plano 4.00d |
46 |
25 |
$1K |
| V2219 |
Lens bifocal seg width over |
14 |
13 |
$1K |
| S0620 |
Routine ophthalmological exa |
24 |
24 |
$880.00 |
| 99213 |
|
17 |
17 |
$864.15 |
| V2784 |
Lens polycarb or equal |
4,889 |
2,441 |
$780.00 |
| S0621 |
Routine ophthalmological exa |
15 |
15 |
$560.00 |
| V2755 |
Uv lens/es |
1,162 |
581 |
$0.00 |
| 3072F |
|
13 |
13 |
$0.00 |