| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
5,730 |
5,678 |
$221K |
| V2020 |
Vision svcs frames purchases |
8,954 |
8,694 |
$111K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
4,114 |
2,900 |
$70K |
| V2100 |
Lens spher single plano 4.00 |
3,334 |
2,294 |
$60K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,105 |
840 |
$26K |
| V2200 |
Lens spher bifoc plano 4.00d |
913 |
619 |
$24K |
| V2784 |
Lens polycarb or equal |
7,941 |
4,930 |
$11K |
| 92340 |
|
1,661 |
1,594 |
$7K |
| 92341 |
|
534 |
523 |
$5K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
162 |
101 |
$3K |
| S0620 |
Routine ophthalmological exa |
80 |
79 |
$2K |
| 92014 |
|
69 |
69 |
$1K |
| V2107 |
Spherocylinder 4.25d/12-2d |
16 |
12 |
$289.24 |
| V2745 |
Tint, any color/solid/grad |
1,049 |
551 |
$276.40 |
| 92015 |
|
4,625 |
4,573 |
$0.00 |