| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological exa |
2,010 |
1,950 |
$83K |
| S0620 |
Routine ophthalmological exa |
1,879 |
1,786 |
$75K |
| V2025 |
Eyeglasses delux frames |
1,685 |
1,637 |
$47K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,068 |
1,036 |
$19K |
| 92340 |
|
459 |
405 |
$12K |
| V2020 |
Vision svcs frames purchases |
740 |
694 |
$11K |
| V2107 |
Spherocylinder 4.25d/12-2d |
638 |
615 |
$10K |
| V2784 |
Lens polycarb or equal |
859 |
821 |
$10K |
| V2100 |
Lens spher single plano 4.00 |
239 |
222 |
$4K |
| V2101 |
Single visn sphere 4.12-7.00 |
196 |
189 |
$3K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
145 |
137 |
$2K |
| 92004 |
|
26 |
24 |
$2K |
| 92015 |
|
150 |
138 |
$2K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
42 |
41 |
$658.31 |
| 92014 |
|
15 |
15 |
$542.88 |
| V2750 |
Anti-reflective coating |
16 |
14 |
$37.62 |