| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
5,729 |
5,127 |
$424K |
| 92014 |
|
3,326 |
2,955 |
$216K |
| V2745 |
Tint, any color/solid/grad |
4,108 |
3,470 |
$187K |
| 92340 |
|
11,114 |
9,748 |
$173K |
| V2750 |
Anti-reflective coating |
2,622 |
2,262 |
$170K |
| V2410 |
Lens variab asphericity sing |
2,014 |
1,647 |
$141K |
| V2020 |
Vision svcs frames purchases |
10,382 |
9,128 |
$120K |
| V2499 |
Variable asphericity lens |
1,847 |
1,715 |
$119K |
| V2784 |
Lens polycarb or equal |
10,331 |
9,072 |
$75K |
| 92015 |
|
9,454 |
8,385 |
$73K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
11,206 |
5,757 |
$58K |
| V2100 |
Lens spher single plano 4.00 |
2,793 |
1,750 |
$12K |
| S0620 |
Routine ophthalmological exa |
137 |
122 |
$4K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
405 |
248 |
$3K |
| V2101 |
Single visn sphere 4.12-7.00 |
57 |
30 |
$361.20 |
| V2755 |
Uv lens/es |
68 |
66 |
$264.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
40 |
24 |
$244.55 |