| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
7,601 |
7,162 |
$292K |
| 92014 |
|
6,462 |
6,221 |
$249K |
| 92015 |
|
8,745 |
8,189 |
$138K |
| V2020 |
Vision svcs frames purchases |
8,842 |
8,169 |
$120K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,999 |
5,542 |
$97K |
| 92310 |
|
1,631 |
1,595 |
$85K |
| 92340 |
|
4,318 |
4,113 |
$85K |
| V2784 |
Lens polycarb or equal |
7,746 |
7,157 |
$84K |
| 92250 |
|
2,574 |
2,421 |
$73K |
| 99203 |
|
1,112 |
1,020 |
$60K |
| 99213 |
|
897 |
824 |
$38K |
| V2303 |
Lens sphcy trifocal 4.0/.12- |
856 |
760 |
$36K |
| 92342 |
|
1,275 |
1,216 |
$31K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,060 |
1,023 |
$29K |
| V2523 |
Cntct lens hydrophil extend |
1,539 |
1,504 |
$19K |
| 92225 |
|
1,134 |
1,052 |
$16K |
| 99204 |
|
205 |
186 |
$10K |
| V2780 |
Oversize lens/es |
428 |
421 |
$8K |
| V2760 |
Scratch resistant coating |
666 |
656 |
$6K |
| 99214 |
|
63 |
60 |
$4K |
| V2750 |
Anti-reflective coating |
176 |
172 |
$3K |
| V2744 |
Tint photochromatic lens/es |
76 |
75 |
$3K |
| 92202 |
|
173 |
161 |
$2K |
| V2100 |
Lens spher single plano 4.00 |
112 |
110 |
$2K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
31 |
29 |
$1K |
| V2521 |
Cntct lens hydrophilic toric |
46 |
45 |
$866.00 |
| 92341 |
|
31 |
30 |
$767.50 |
| V2200 |
Lens spher bifoc plano 4.00d |
18 |
14 |
$521.50 |
| 3072F |
|
170 |
169 |
$300.00 |
| 2026F |
|
177 |
156 |
$0.00 |