| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
3,535 |
3,358 |
$224K |
| 92004 |
|
1,559 |
1,463 |
$134K |
| V2020 |
Frames, purchases |
2,813 |
2,604 |
$73K |
| 92250 |
|
1,539 |
1,407 |
$64K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,715 |
946 |
$20K |
| 99214 |
|
269 |
221 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
230 |
149 |
$3K |
| V2756 |
Eye glass case |
2,540 |
2,357 |
$3K |
| 92370 |
|
122 |
120 |
$2K |
| 99213 |
|
18 |
15 |
$591.12 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
15 |
12 |
$178.64 |
| 92015 |
|
118 |
96 |
$0.00 |