| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
|
2,769 |
2,763 |
$179K |
| 92014 |
|
1,900 |
1,894 |
$171K |
| 92004 |
|
1,059 |
1,058 |
$101K |
| 92012 |
|
1,056 |
868 |
$87K |
| 92310 |
|
214 |
214 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
55 |
52 |
$3K |
| 92250 |
|
72 |
72 |
$2K |
| 92002 |
|
12 |
12 |
$1K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
14 |
14 |
$850.00 |
| V2020 |
Frames, purchases |
45 |
43 |
$600.00 |
| 92340 |
|
99 |
94 |
$290.00 |
| 92060 |
|
17 |
17 |
$252.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$168.00 |
| V2755 |
U-v lens, per lens |
82 |
75 |
$100.24 |
| V2750 |
Anti-reflective coating, per lens |
13 |
12 |
$0.00 |
| 2023F |
|
1,068 |
1,068 |
$0.00 |
| 3072F |
|
33 |
31 |
$0.00 |