| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
4,680 |
4,333 |
$370K |
| V2020 |
Frames, purchases |
4,767 |
4,364 |
$145K |
| 92004 |
|
1,082 |
1,009 |
$99K |
| 92015 |
|
6,870 |
6,357 |
$85K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,033 |
812 |
$35K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,252 |
1,155 |
$31K |
| V2755 |
U-v lens, per lens |
1,712 |
1,508 |
$29K |
| 99213 |
|
196 |
159 |
$10K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
22 |
14 |
$1K |
| G9903 |
Patient screened for tobacco use and identified as a tobacco non-user |
252 |
212 |
$0.00 |
| 1036F |
|
567 |
476 |
$0.00 |
| 2026F |
|
13 |
13 |
$0.00 |