| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
1,459 |
1,330 |
$130K |
| V2020 |
Frames, purchases |
2,818 |
2,472 |
$106K |
| 92014 |
|
1,158 |
1,064 |
$100K |
| 99213 |
|
703 |
588 |
$44K |
| 92015 |
|
3,178 |
2,922 |
$41K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
986 |
559 |
$23K |
| V2303 |
Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens |
170 |
81 |
$7K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
106 |
89 |
$4K |
| 92250 |
|
66 |
62 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
37 |
24 |
$791.88 |