| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
19,704 |
19,209 |
$1.17M |
| 92250 |
|
19,393 |
19,250 |
$893K |
| 92004 |
|
6,696 |
6,663 |
$493K |
| V2020 |
Vision svcs frames purchases |
22,208 |
21,782 |
$273K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
15,760 |
8,690 |
$189K |
| V2100 |
Lens spher single plano 4.00 |
14,875 |
7,898 |
$185K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
5,209 |
2,929 |
$86K |
| 92083 |
|
1,492 |
1,490 |
$74K |
| V2200 |
Lens spher bifoc plano 4.00d |
3,288 |
1,685 |
$57K |
| 92060 |
|
1,006 |
987 |
$39K |
| 92340 |
|
2,826 |
2,795 |
$37K |
| 92015 |
|
3,050 |
3,006 |
$36K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
508 |
497 |
$29K |
| 92133 |
|
771 |
770 |
$23K |
| 68761 |
|
261 |
137 |
$19K |
| 92145 |
|
1,934 |
1,895 |
$18K |
| 92012 |
|
329 |
322 |
$14K |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
52 |
52 |
$9K |
| 99214 |
|
95 |
94 |
$6K |
| 92285 |
|
141 |
138 |
$4K |
| V2784 |
Lens polycarb or equal |
9,564 |
4,731 |
$4K |
| 92341 |
|
164 |
163 |
$3K |
| 99204 |
|
18 |
18 |
$2K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
516 |
256 |
$1K |
| S0580 |
Polycarb lens |
93 |
90 |
$810.00 |
| V2299 |
Lens bifocal speciality |
56 |
28 |
$286.64 |
| V2107 |
Spherocylinder 4.25d/12-2d |
24 |
12 |
$41.08 |
| V2750 |
Anti-reflective coating |
132 |
66 |
$0.00 |
| V2755 |
Uv lens/es |
4,048 |
2,015 |
$0.00 |
| V2781 |
Progressive lens per lens |
56 |
28 |
$0.00 |