| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
3,685 |
3,581 |
$194K |
| 92014 |
|
3,518 |
3,507 |
$194K |
| V2784 |
Lens polycarb or equal |
2,448 |
1,874 |
$58K |
| 92015 |
|
4,685 |
4,670 |
$53K |
| 92340 |
|
3,685 |
3,631 |
$49K |
| V2020 |
Vision svcs frames purchases |
4,482 |
4,465 |
$46K |
| 92250 |
|
671 |
670 |
$33K |
| S0580 |
Polycarb lens |
1,752 |
1,718 |
$30K |
| V2100 |
Lens spher single plano 4.00 |
2,218 |
1,387 |
$23K |
| 99214 |
|
363 |
362 |
$18K |
| 92025 |
|
371 |
369 |
$18K |
| 99213 |
|
485 |
450 |
$16K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,695 |
1,526 |
$13K |
| 92012 |
|
297 |
281 |
$12K |
| V2101 |
Single visn sphere 4.12-7.00 |
788 |
776 |
$10K |
| 99204 |
|
136 |
135 |
$10K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
900 |
848 |
$8K |
| V2500 |
Contact lens pmma spherical |
16 |
16 |
$5K |
| 92341 |
|
215 |
214 |
$4K |
| 92083 |
|
26 |
26 |
$2K |
| 92310 |
|
13 |
13 |
$2K |
| V2107 |
Spherocylinder 4.25d/12-2d |
94 |
94 |
$1K |
| 92225 |
|
69 |
68 |
$945.00 |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
41 |
41 |
$896.40 |
| V2102 |
Singl visn sphere 7.12-20.00 |
31 |
31 |
$613.80 |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
15 |
15 |
$243.00 |