| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
5,655 |
5,630 |
$77K |
| 92014 |
|
2,609 |
2,605 |
$58K |
| 92340 |
|
1,738 |
1,733 |
$32K |
| 92015 |
|
1,355 |
1,353 |
$5K |
| V2020 |
Vision svcs frames purchases |
7,232 |
7,151 |
$840.00 |
| V2520 |
Contact lens hydrophilic |
14 |
14 |
$750.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,584 |
997 |
$415.00 |
| V2100 |
Lens spher single plano 4.00 |
3,280 |
2,042 |
$294.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
6,017 |
3,365 |
$231.00 |
| 92341 |
|
14 |
14 |
$200.00 |
| V2784 |
Lens polycarb or equal |
5,229 |
2,793 |
$0.00 |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
21 |
12 |
$0.00 |
| V2200 |
Lens spher bifoc plano 4.00d |
154 |
99 |
$0.00 |
| 3072F |
|
1,184 |
1,177 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
43 |
43 |
$0.00 |
| S0621 |
Routine ophthalmological exa |
82 |
82 |
$0.00 |