| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
3,756 |
3,604 |
$251K |
| 92004 |
|
1,989 |
1,917 |
$178K |
| V2020 |
Frames, purchases |
4,586 |
4,389 |
$135K |
| 92340 |
|
3,407 |
3,282 |
$101K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,738 |
2,606 |
$48K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,908 |
2,820 |
$23K |
| 99213 |
|
659 |
545 |
$21K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
895 |
862 |
$14K |
| 92015 |
|
4,451 |
4,270 |
$8K |
| 92250 |
|
205 |
177 |
$7K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
109 |
90 |
$3K |
| 92370 |
|
79 |
75 |
$2K |
| 92341 |
|
47 |
41 |
$891.00 |
| V2715 |
Prism, per lens |
13 |
13 |
$0.00 |