| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
2,275 |
2,267 |
$3K |
| 92014 |
|
9,386 |
9,353 |
$2K |
| V2784 |
Lens polycarb or equal |
11,052 |
5,633 |
$2K |
| V2020 |
Vision svcs frames purchases |
11,947 |
11,560 |
$864.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,741 |
1,555 |
$816.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,126 |
615 |
$405.00 |
| V2100 |
Lens spher single plano 4.00 |
13,315 |
6,686 |
$232.00 |
| 92012 |
|
1,083 |
1,073 |
$22.00 |
| V2200 |
Lens spher bifoc plano 4.00d |
3,057 |
1,530 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
397 |
204 |
$0.00 |
| V2781 |
Progressive lens per lens |
26 |
13 |
$0.00 |
| 92002 |
|
208 |
208 |
$0.00 |
| V2521 |
Cntct lens hydrophilic toric |
27 |
27 |
$0.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
124 |
66 |
$0.00 |
| V2599 |
Contact lens/es other type |
38 |
38 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
127 |
127 |
$0.00 |
| V2299 |
Lens bifocal speciality |
24 |
12 |
$0.00 |
| V2520 |
Contact lens hydrophilic |
42 |
42 |
$0.00 |
| S0621 |
Routine ophthalmological exa |
298 |
298 |
$0.00 |
| 92015 |
|
26 |
26 |
$0.00 |