| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
12,820 |
11,901 |
$1.19M |
| 92004 |
|
6,330 |
6,203 |
$558K |
| 92250 |
|
7,736 |
6,890 |
$384K |
| 99204 |
|
2,081 |
1,958 |
$303K |
| V2020 |
Vision svcs frames purchases |
13,070 |
12,891 |
$274K |
| 92015 |
|
15,220 |
13,897 |
$239K |
| 92340 |
|
12,823 |
12,734 |
$216K |
| 92025 |
|
4,689 |
4,399 |
$143K |
| 92273 |
|
1,113 |
1,033 |
$125K |
| V2100 |
Lens spher single plano 4.00 |
4,239 |
4,166 |
$103K |
| 92083 |
|
1,794 |
1,725 |
$98K |
| 92133 |
|
1,969 |
1,828 |
$74K |
| 92283 |
|
1,292 |
1,249 |
$60K |
| V2784 |
Lens polycarb or equal |
7,176 |
7,119 |
$60K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,332 |
5,285 |
$49K |
| V2760 |
Scratch resistant coating |
2,365 |
2,339 |
$40K |
| 92285 |
|
2,475 |
2,237 |
$40K |
| V2025 |
Eyeglasses delux frames |
1,045 |
1,044 |
$38K |
| 99214 |
|
324 |
297 |
$31K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,014 |
999 |
$29K |
| 92020 |
|
1,785 |
1,369 |
$29K |
| 92275 |
|
171 |
171 |
$24K |
| A4556 |
Electrodes, pair |
1,597 |
1,496 |
$22K |
| 76514 |
|
1,390 |
1,367 |
$20K |
| V2200 |
Lens spher bifoc plano 4.00d |
518 |
505 |
$19K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
2,313 |
2,296 |
$15K |
| V2755 |
Uv lens/es |
424 |
414 |
$9K |
| 0509T |
|
148 |
146 |
$7K |
| A4558 |
Conductive gel or paste |
1,597 |
1,496 |
$5K |
| 99203 |
|
35 |
35 |
$3K |
| 92341 |
|
68 |
68 |
$2K |
| 99213 |
|
22 |
21 |
$1K |
| V2107 |
Spherocylinder 4.25d/12-2d |
85 |
84 |
$1K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
145 |
141 |
$840.40 |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
16 |
16 |
$415.08 |
| V2750 |
Anti-reflective coating |
810 |
800 |
$240.00 |
| 99199 |
|
161 |
161 |
$0.00 |
| 99072 |
|
2,182 |
2,074 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
760 |
757 |
$0.00 |