| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
1,333 |
1,246 |
$108K |
| 92014 |
|
1,611 |
1,418 |
$95K |
| V2020 |
Frames, purchases |
2,093 |
1,716 |
$27K |
| 92340 |
|
1,227 |
1,023 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
934 |
766 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
462 |
427 |
$8K |
| 92012 |
|
56 |
44 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
19 |
15 |
$886.34 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
30 |
12 |
$595.00 |
| 99211 |
|
88 |
86 |
$459.66 |
| 92250 |
|
14 |
12 |
$418.69 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
13 |
$0.00 |
| 92015 |
|
2,202 |
1,790 |
$0.00 |