| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
5,191 |
5,147 |
$40K |
| 92004 |
|
1,912 |
1,909 |
$36K |
| V2100 |
Lens spher single plano 4.00 |
2,535 |
1,435 |
$31K |
| V2199 |
Lens single vision not oth c |
2,808 |
1,403 |
$29K |
| V2299 |
Lens bifocal speciality |
1,056 |
527 |
$14K |
| V2200 |
Lens spher bifoc plano 4.00d |
726 |
443 |
$14K |
| 92340 |
|
810 |
807 |
$9K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,175 |
597 |
$7K |
| 92002 |
|
99 |
99 |
$4K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
420 |
210 |
$3K |
| 92014 |
|
77 |
77 |
$2K |
| S0620 |
Routine ophthalmological exa |
97 |
97 |
$2K |
| 92341 |
|
37 |
37 |
$648.00 |
| S0580 |
Polycarb lens |
68 |
68 |
$603.00 |
| 92015 |
|
56 |
56 |
$324.00 |
| V2760 |
Scratch resistant coating |
356 |
178 |
$20.00 |
| V2784 |
Lens polycarb or equal |
5,775 |
2,860 |
$10.00 |
| V2745 |
Tint, any color/solid/grad |
36 |
18 |
$10.00 |
| V2755 |
Uv lens/es |
2,696 |
1,344 |
$0.00 |
| V2799 |
Misc vision item or service |
138 |
114 |
$0.00 |