| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
774 |
772 |
$28K |
| V2020 |
Vision svcs frames purchases |
8,249 |
8,146 |
$19K |
| V2784 |
Lens polycarb or equal |
5,800 |
2,986 |
$4K |
| 92015 |
|
1,203 |
1,198 |
$3K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
2,457 |
1,297 |
$3K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,969 |
3,066 |
$2K |
| 92250 |
|
67 |
66 |
$2K |
| 92004 |
|
31 |
31 |
$945.20 |
| V2100 |
Lens spher single plano 4.00 |
2,387 |
1,234 |
$602.80 |
| V2200 |
Lens spher bifoc plano 4.00d |
12 |
12 |
$286.00 |
| 92340 |
|
13 |
13 |
$160.00 |
| V2599 |
Contact lens/es other type |
142 |
142 |
$0.00 |
| V2299 |
Lens bifocal speciality |
74 |
37 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
354 |
176 |
$0.00 |
| V2781 |
Progressive lens per lens |
74 |
37 |
$0.00 |
| V2750 |
Anti-reflective coating |
1,050 |
521 |
$0.00 |
| V2500 |
Contact lens pmma spherical |
217 |
217 |
$0.00 |
| V2520 |
Contact lens hydrophilic |
358 |
358 |
$0.00 |
| V2501 |
Cntct lens pmma-toric/prism |
13 |
13 |
$0.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
54 |
26 |
$0.00 |