| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
1,309 |
1,281 |
$114K |
| 92340 |
|
1,712 |
1,664 |
$96K |
| 92014 |
|
1,318 |
1,284 |
$84K |
| 99213 |
|
838 |
760 |
$33K |
| V2020 |
Frames, purchases |
922 |
850 |
$30K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
609 |
564 |
$19K |
| 92015 |
|
833 |
804 |
$13K |
| 99203 |
|
125 |
116 |
$8K |
| 92002 |
|
117 |
113 |
$6K |
| 92012 |
|
78 |
74 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
445 |
407 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
47 |
43 |
$3K |
| V2760 |
Scratch resistant coating, per lens |
382 |
374 |
$734.20 |
| 92134 |
|
15 |
14 |
$536.17 |