| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
5,075 |
5,033 |
$186K |
| 92082 |
|
4,176 |
4,140 |
$60K |
| 92012 |
|
119 |
114 |
$2K |
| 99212 |
|
97 |
90 |
$2K |
| 92133 |
|
53 |
53 |
$1K |
| 92083 |
|
63 |
63 |
$976.00 |
| 99213 |
|
27 |
27 |
$665.01 |
| 92014 |
|
7,992 |
7,946 |
$423.00 |
| 92134 |
|
13 |
12 |
$271.37 |
| 92004 |
|
1,844 |
1,835 |
$264.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
185 |
99 |
$57.16 |
| V2100 |
Lens spher single plano 4.00 |
9,373 |
4,963 |
$41.08 |
| V2020 |
Vision svcs frames purchases |
6,647 |
6,477 |
$23.00 |
| V2750 |
Anti-reflective coating |
3,022 |
1,502 |
$0.00 |
| V2500 |
Contact lens pmma spherical |
242 |
237 |
$0.00 |
| S0621 |
Routine ophthalmological exa |
14 |
14 |
$0.00 |
| V2760 |
Scratch resistant coating |
30 |
13 |
$0.00 |
| V2784 |
Lens polycarb or equal |
7,526 |
3,888 |
$0.00 |
| V2781 |
Progressive lens per lens |
904 |
448 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
690 |
335 |
$0.00 |
| V2299 |
Lens bifocal speciality |
764 |
371 |
$0.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,458 |
747 |
$0.00 |
| V2200 |
Lens spher bifoc plano 4.00d |
414 |
218 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
147 |
147 |
$0.00 |