| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
2,685 |
2,308 |
$77K |
| 92014 |
|
1,013 |
912 |
$73K |
| 92012 |
|
1,002 |
962 |
$68K |
| V2100 |
Lens spher single plano 4.00 |
1,732 |
1,523 |
$53K |
| 92340 |
|
2,681 |
2,309 |
$37K |
| 92004 |
|
49 |
45 |
$4K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
28 |
24 |
$1K |
| V2101 |
Single visn sphere 4.12-7.00 |
24 |
24 |
$883.20 |
| V2102 |
Singl visn sphere 7.12-20.00 |
13 |
13 |
$665.86 |
| V2200 |
Lens spher bifoc plano 4.00d |
13 |
12 |
$602.88 |
| V2784 |
Lens polycarb or equal |
414 |
331 |
$198.16 |
| V2745 |
Tint, any color/solid/grad |
277 |
228 |
$1.00 |
| S0620 |
Routine ophthalmological exa |
16 |
16 |
$0.00 |