| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
|
1,468 |
1,442 |
$101K |
| V2784 |
Lens polycarb or equal |
2,516 |
2,481 |
$63K |
| V2025 |
Eyeglasses delux frames |
1,479 |
1,476 |
$56K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,625 |
2,594 |
$53K |
| S0621 |
Routine ophthalmological exa |
1,181 |
1,178 |
$51K |
| V2020 |
Vision svcs frames purchases |
2,748 |
2,687 |
$47K |
| S0620 |
Routine ophthalmological exa |
501 |
501 |
$21K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,109 |
1,091 |
$20K |
| 92015 |
|
1,630 |
1,620 |
$19K |
| 92004 |
|
105 |
105 |
$11K |
| 92002 |
|
107 |
106 |
$8K |
| V2100 |
Lens spher single plano 4.00 |
117 |
116 |
$2K |
| V2107 |
Spherocylinder 4.25d/12-2d |
47 |
47 |
$813.48 |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
42 |
42 |
$697.05 |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
12 |
12 |
$368.08 |