| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
11,464 |
10,214 |
$430K |
| 92285 |
|
10,988 |
9,470 |
$244K |
| 92250 |
|
6,133 |
6,054 |
$214K |
| V2100 |
Lens spher single plano 4.00 |
11,707 |
5,344 |
$177K |
| V2020 |
Vision svcs frames purchases |
12,189 |
11,304 |
$140K |
| 92132 |
|
6,119 |
6,082 |
$139K |
| 92014 |
|
1,761 |
1,682 |
$85K |
| V2200 |
Lens spher bifoc plano 4.00d |
4,821 |
2,167 |
$81K |
| 92134 |
|
3,064 |
3,005 |
$43K |
| 92083 |
|
904 |
899 |
$40K |
| 92133 |
|
1,093 |
1,079 |
$20K |
| 99204 |
|
441 |
434 |
$19K |
| 92082 |
|
377 |
368 |
$15K |
| 76514 |
|
2,517 |
2,459 |
$13K |
| 92081 |
|
321 |
317 |
$10K |
| 92012 |
|
227 |
207 |
$8K |
| V2106 |
Spherocylinder 4.00d/>6.00d |
1,444 |
817 |
$5K |
| 92341 |
|
1,163 |
1,135 |
$4K |
| 92342 |
|
1,671 |
1,651 |
$3K |
| 92340 |
|
4,000 |
3,886 |
$2K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
402 |
199 |
$2K |
| V2101 |
Single visn sphere 4.12-7.00 |
374 |
227 |
$1K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
229 |
117 |
$1K |
| V2206 |
Lens sphcy bifocal 4.00d/ove |
260 |
140 |
$880.18 |
| 92025 |
|
9,059 |
8,787 |
$266.32 |
| V2784 |
Lens polycarb or equal |
3,608 |
1,773 |
$240.00 |
| 92060 |
|
40 |
33 |
$105.78 |
| V2760 |
Scratch resistant coating |
505 |
304 |
$0.00 |
| 92015 |
|
9,480 |
9,142 |
$0.00 |
| 2024F |
|
726 |
721 |
$0.00 |
| V2750 |
Anti-reflective coating |
349 |
227 |
$0.00 |
| 2022F |
|
224 |
220 |
$0.00 |
| V2781 |
Progressive lens per lens |
1,250 |
651 |
$0.00 |
| 2023F |
|
72 |
68 |
$0.00 |
| V2755 |
Uv lens/es |
54 |
27 |
$0.00 |