| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
25,786 |
25,678 |
$260K |
| 92004 |
|
10,076 |
10,042 |
$76K |
| 66984 |
|
285 |
226 |
$61K |
| 99214 |
|
1,772 |
1,695 |
$55K |
| 92012 |
|
1,837 |
1,777 |
$41K |
| 99213 |
|
1,286 |
1,243 |
$39K |
| 92015 |
|
12,150 |
12,088 |
$20K |
| 92134 |
|
1,991 |
1,980 |
$20K |
| 99204 |
|
261 |
258 |
$17K |
| 92340 |
|
705 |
703 |
$14K |
| 67028 |
|
214 |
205 |
$9K |
| 92133 |
|
316 |
311 |
$5K |
| 92083 |
|
286 |
283 |
$4K |
| 92250 |
|
104 |
103 |
$4K |
| 92136 |
|
212 |
143 |
$3K |
| 99203 |
|
38 |
38 |
$2K |
| V2020 |
Vision svcs frames purchases |
20,618 |
20,405 |
$2K |
| 92060 |
|
56 |
56 |
$1K |
| 92020 |
|
136 |
132 |
$1K |
| V2784 |
Lens polycarb or equal |
20,865 |
10,500 |
$1K |
| V2100 |
Lens spher single plano 4.00 |
11,506 |
5,790 |
$786.50 |
| 99212 |
|
13 |
12 |
$281.88 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
11,291 |
5,694 |
$148.00 |
| V2599 |
Contact lens/es other type |
27 |
27 |
$100.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
2,049 |
1,038 |
$54.00 |
| V2200 |
Lens spher bifoc plano 4.00d |
1,284 |
642 |
$52.00 |
| V2744 |
Tint photochromatic lens/es |
3,157 |
1,573 |
$0.00 |
| 2023F |
|
681 |
666 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
269 |
269 |
$0.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
578 |
298 |
$0.00 |
| V2299 |
Lens bifocal speciality |
1,198 |
595 |
$0.00 |
| V2781 |
Progressive lens per lens |
1,422 |
707 |
$0.00 |
| S0500 |
Dispos cont lens |
14 |
14 |
$0.00 |
| V2760 |
Scratch resistant coating |
4,422 |
2,237 |
$0.00 |
| V2750 |
Anti-reflective coating |
6,948 |
3,441 |
$0.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
570 |
282 |
$0.00 |
| S0621 |
Routine ophthalmological exa |
604 |
604 |
$0.00 |