| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
15,650 |
14,084 |
$706K |
| 92340 |
|
16,388 |
14,416 |
$471K |
| 92015 |
|
23,353 |
21,039 |
$338K |
| 92014 |
|
7,666 |
6,799 |
$333K |
| V2025 |
Eyeglasses delux frames |
8,526 |
7,925 |
$304K |
| V2020 |
Vision svcs frames purchases |
8,608 |
7,528 |
$129K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
7,882 |
6,839 |
$102K |
| V2784 |
Lens polycarb or equal |
5,815 |
4,805 |
$51K |
| V2100 |
Lens spher single plano 4.00 |
3,853 |
3,583 |
$46K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
2,402 |
2,045 |
$29K |
| S0621 |
Routine ophthalmological exa |
502 |
498 |
$22K |
| 92012 |
|
382 |
305 |
$17K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,017 |
906 |
$17K |
| S0620 |
Routine ophthalmological exa |
316 |
314 |
$15K |
| V2200 |
Lens spher bifoc plano 4.00d |
327 |
313 |
$6K |
| V2107 |
Spherocylinder 4.25d/12-2d |
470 |
398 |
$6K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
167 |
145 |
$2K |