| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
5,209 |
4,462 |
$226K |
| V2100 |
Lens spher single plano 4.00 |
4,361 |
3,563 |
$162K |
| V2784 |
Lens polycarb or equal |
1,284 |
1,065 |
$48K |
| 92014 |
|
495 |
485 |
$20K |
| 92004 |
|
429 |
418 |
$18K |
| V2750 |
Anti-reflective coating |
492 |
397 |
$14K |
| S0621 |
Routine ophthalmological exa |
228 |
228 |
$7K |
| V2500 |
Contact lens pmma spherical |
93 |
66 |
$6K |
| S0620 |
Routine ophthalmological exa |
152 |
152 |
$5K |
| 92012 |
|
110 |
110 |
$4K |
| V2200 |
Lens spher bifoc plano 4.00d |
48 |
39 |
$2K |
| V2744 |
Tint photochromatic lens/es |
13 |
13 |
$783.52 |
| 92310 |
|
13 |
13 |
$385.00 |
| V2799 |
Misc vision item or service |
930 |
696 |
$0.00 |
| 92250 |
|
13 |
13 |
$0.00 |
| V2797 |
Vis item/svc in other code |
49 |
49 |
$0.00 |