| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
11,350 |
10,640 |
$994K |
| 92004 |
|
6,556 |
6,073 |
$651K |
| V2020 |
Vision svcs frames purchases |
17,873 |
15,958 |
$592K |
| 92015 |
|
21,406 |
19,800 |
$302K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
10,579 |
6,405 |
$295K |
| V2784 |
Lens polycarb or equal |
4,659 |
3,994 |
$248K |
| 99214 |
|
1,856 |
1,693 |
$128K |
| V2303 |
Lens sphcy trifocal 4.0/.12- |
2,711 |
1,447 |
$119K |
| 99213 |
|
1,131 |
1,007 |
$71K |
| V2100 |
Lens spher single plano 4.00 |
1,869 |
1,439 |
$52K |
| 92250 |
|
1,292 |
1,167 |
$37K |
| V2300 |
Lens sphere trifocal 4.00d |
694 |
420 |
$31K |
| V2755 |
Uv lens/es |
1,117 |
1,060 |
$22K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
250 |
153 |
$10K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
200 |
138 |
$5K |
| 99204 |
|
45 |
39 |
$4K |
| 99203 |
|
26 |
25 |
$2K |
| V2107 |
Spherocylinder 4.25d/12-2d |
43 |
27 |
$1K |
| V2304 |
Lens sphcy trifocal 4.0/2.25 |
13 |
12 |
$587.46 |
| 92020 |
|
13 |
13 |
$245.51 |
| V2781 |
Progressive lens per lens |
38 |
30 |
$55.00 |