| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens polycarb or equal |
4,988 |
4,094 |
$284K |
| 92014 |
|
3,012 |
2,973 |
$134K |
| V2102 |
Singl visn sphere 7.12-20.00 |
1,578 |
1,407 |
$63K |
| 92004 |
|
898 |
894 |
$51K |
| V2020 |
Vision svcs frames purchases |
5,210 |
4,332 |
$50K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,479 |
1,151 |
$45K |
| V2202 |
Lens sphere bifocal 7.12-20. |
630 |
539 |
$31K |
| 92015 |
|
4,080 |
4,031 |
$21K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
556 |
421 |
$20K |
| 92012 |
|
313 |
291 |
$9K |
| S0621 |
Routine ophthalmological exa |
73 |
60 |
$2K |
| V2100 |
Lens spher single plano 4.00 |
85 |
65 |
$2K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
49 |
38 |
$1K |
| V2107 |
Spherocylinder 4.25d/12-2d |
33 |
27 |
$1K |
| 92134 |
|
29 |
27 |
$857.22 |
| S0620 |
Routine ophthalmological exa |
19 |
12 |
$570.00 |
| 92310 |
|
106 |
105 |
$0.00 |