| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
14,425 |
11,913 |
$766K |
| 92004 |
|
5,709 |
4,732 |
$372K |
| V2100 |
Lens spher single plano 4.00 |
7,760 |
5,388 |
$183K |
| V2020 |
Vision svcs frames purchases |
13,475 |
9,750 |
$144K |
| 92012 |
|
3,769 |
3,081 |
$105K |
| 92015 |
|
16,759 |
13,488 |
$94K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,483 |
2,699 |
$94K |
| 99211 |
|
4,000 |
3,754 |
$50K |
| 92250 |
|
1,346 |
1,189 |
$26K |
| 92340 |
|
737 |
707 |
$9K |
| V2799 |
Misc vision item or service |
279 |
272 |
$4K |
| V2200 |
Lens spher bifoc plano 4.00d |
37 |
26 |
$2K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
17 |
13 |
$1K |
| V2025 |
Eyeglasses delux frames |
33 |
24 |
$903.23 |
| V2784 |
Lens polycarb or equal |
129 |
95 |
$127.00 |
| G8427 |
Docrev cur meds by elig clin |
286 |
217 |
$0.00 |
| 2026F |
|
425 |
271 |
$0.00 |
| G8785 |
Bp scrn no perf at interval |
41 |
27 |
$0.00 |
| 2025F |
|
31 |
30 |
$0.00 |
| G9744 |
Pt not eli d/t act dig htn |
63 |
55 |
$0.00 |
| G8730 |
Pain doc pos and plan |
13 |
12 |
$0.00 |
| G8732 |
No doc of pain |
204 |
146 |
$0.00 |
| 3072F |
|
115 |
108 |
$0.00 |
| G9903 |
Pt scrn tbco id as non user |
14 |
12 |
$0.00 |
| 1036F |
|
17 |
12 |
$0.00 |
| G8428 |
Cur meds not document |
213 |
150 |
$0.00 |
| S0580 |
Polycarb lens |
14 |
14 |
$0.00 |