| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
3,936 |
3,889 |
$259K |
| 92014 |
|
2,277 |
2,254 |
$121K |
| 92250 |
|
2,459 |
2,415 |
$110K |
| V2100 |
Lens spher single plano 4.00 |
6,312 |
3,414 |
$96K |
| V2020 |
Vision svcs frames purchases |
7,696 |
7,585 |
$95K |
| 92083 |
|
1,186 |
1,175 |
$56K |
| 68761 |
|
394 |
251 |
$34K |
| 92202 |
|
990 |
953 |
$25K |
| 92060 |
|
731 |
705 |
$25K |
| V2200 |
Lens spher bifoc plano 4.00d |
1,120 |
612 |
$20K |
| 76512 |
|
225 |
128 |
$19K |
| 92340 |
|
1,351 |
1,346 |
$18K |
| 92015 |
|
1,328 |
1,318 |
$16K |
| 92285 |
|
456 |
450 |
$11K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,341 |
797 |
$8K |
| S0580 |
Polycarb lens |
445 |
443 |
$7K |
| V2102 |
Singl visn sphere 7.12-20.00 |
213 |
212 |
$4K |
| V2784 |
Lens polycarb or equal |
1,554 |
814 |
$3K |
| 92012 |
|
49 |
49 |
$2K |
| V2202 |
Lens sphere bifocal 7.12-20. |
44 |
44 |
$2K |
| 92341 |
|
74 |
73 |
$1K |
| 92225 |
|
52 |
49 |
$795.24 |
| V2101 |
Single visn sphere 4.12-7.00 |
52 |
50 |
$716.50 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
76 |
41 |
$538.12 |
| S0620 |
Routine ophthalmological exa |
13 |
13 |
$165.00 |