| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
7,828 |
7,271 |
$360K |
| 92340 |
|
10,548 |
9,989 |
$302K |
| 92014 |
|
5,385 |
5,091 |
$239K |
| V2025 |
Eyeglasses delux frames |
7,331 |
6,832 |
$224K |
| 92015 |
|
12,836 |
12,196 |
$212K |
| V2100 |
Lens spher single plano 4.00 |
6,127 |
5,647 |
$160K |
| V2200 |
Lens spher bifoc plano 4.00d |
3,053 |
2,792 |
$150K |
| 92310 |
|
1,423 |
1,352 |
$72K |
| V2523 |
Cntct lens hydrophil extend |
637 |
600 |
$56K |
| 92012 |
|
729 |
632 |
$33K |
| V2020 |
Vision svcs frames purchases |
1,893 |
1,738 |
$27K |
| V2784 |
Lens polycarb or equal |
3,111 |
3,045 |
$26K |
| 92341 |
|
920 |
883 |
$26K |
| S0620 |
Routine ophthalmological exa |
556 |
549 |
$25K |
| S0621 |
Routine ophthalmological exa |
420 |
409 |
$19K |
| V2599 |
Contact lens/es other type |
102 |
98 |
$8K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
159 |
158 |
$1K |
| 3072F |
|
913 |
913 |
$0.00 |
| V2781 |
Progressive lens per lens |
30 |
30 |
$0.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
80 |
80 |
$0.00 |
| V2760 |
Scratch resistant coating |
40 |
19 |
$0.00 |