| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
1,128 |
1,094 |
$78K |
| V2020 |
Frames, purchases |
3,185 |
2,826 |
$62K |
| 92004 |
|
558 |
519 |
$46K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,132 |
1,012 |
$18K |
| 92012 |
|
353 |
302 |
$16K |
| 99211 |
|
1,112 |
1,091 |
$14K |
| 99213 |
|
162 |
149 |
$6K |
| 92250 |
|
101 |
92 |
$4K |
| 92083 |
|
83 |
76 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
204 |
191 |
$3K |
| 92340 |
|
103 |
99 |
$964.08 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$657.44 |