| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
2,419 |
2,417 |
$312K |
| 92014 |
|
2,359 |
2,352 |
$265K |
| V2020 |
Vision svcs frames purchases |
6,080 |
6,051 |
$224K |
| 92340 |
|
3,993 |
3,966 |
$112K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,792 |
3,056 |
$84K |
| V2784 |
Lens polycarb or equal |
5,298 |
3,883 |
$60K |
| V2025 |
Eyeglasses delux frames |
648 |
645 |
$37K |
| 92012 |
|
305 |
305 |
$22K |
| V2100 |
Lens spher single plano 4.00 |
804 |
673 |
$18K |
| 92015 |
|
3,548 |
3,539 |
$17K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
562 |
495 |
$15K |
| 92341 |
|
148 |
148 |
$6K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
124 |
124 |
$5K |
| V2107 |
Spherocylinder 4.25d/12-2d |
96 |
82 |
$2K |
| 99213 |
|
28 |
28 |
$1K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
42 |
37 |
$787.63 |
| V2200 |
Lens spher bifoc plano 4.00d |
13 |
13 |
$742.95 |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
14 |
12 |
$136.22 |
| V2744 |
Tint photochromatic lens/es |
81 |
81 |
$80.00 |
| V2750 |
Anti-reflective coating |
25 |
25 |
$0.00 |
| 2023F |
|
37 |
37 |
$0.00 |