| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological exa |
17,699 |
17,088 |
$733K |
| V2020 |
Vision svcs frames purchases |
21,353 |
20,432 |
$386K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
19,683 |
18,821 |
$335K |
| S0620 |
Routine ophthalmological exa |
7,774 |
7,527 |
$317K |
| V2784 |
Lens polycarb or equal |
18,084 |
17,390 |
$197K |
| V2025 |
Eyeglasses delux frames |
5,498 |
5,390 |
$178K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
3,037 |
2,897 |
$44K |
| V2100 |
Lens spher single plano 4.00 |
1,626 |
1,555 |
$21K |
| 92015 |
|
33,599 |
31,891 |
$8K |
| V2750 |
Anti-reflective coating |
895 |
863 |
$6K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
128 |
121 |
$4K |
| V2799 |
Misc vision item or service |
417 |
389 |
$3K |
| 92014 |
|
619 |
544 |
$3K |
| 92250 |
|
308 |
305 |
$2K |
| 92004 |
|
172 |
166 |
$1K |
| 99203 |
|
268 |
265 |
$1K |
| V2107 |
Spherocylinder 4.25d/12-2d |
67 |
66 |
$918.84 |
| V2755 |
Uv lens/es |
37 |
37 |
$308.78 |
| 99213 |
|
158 |
149 |
$305.31 |
| V2744 |
Tint photochromatic lens/es |
63 |
63 |
$181.86 |
| V2760 |
Scratch resistant coating |
215 |
215 |
$41.56 |
| S9986 |
Not medically necessary svc |
1,647 |
1,514 |
$0.00 |
| 92002 |
|
13 |
13 |
$0.00 |