| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
4,872 |
4,372 |
$209K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,960 |
2,514 |
$117K |
| 92340 |
|
3,790 |
3,473 |
$100K |
| 92004 |
|
2,035 |
1,838 |
$93K |
| 92015 |
|
5,796 |
5,358 |
$88K |
| V2020 |
Frames, purchases |
2,886 |
2,780 |
$71K |
| 92012 |
|
1,183 |
966 |
$53K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,251 |
2,179 |
$28K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,030 |
1,026 |
$13K |
| V2025 |
Deluxe frame |
1,152 |
845 |
$13K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
59 |
56 |
$3K |
| 92370 |
|
479 |
385 |
$2K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
14 |
13 |
$630.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
58 |
58 |
$600.48 |
| 92341 |
|
13 |
13 |
$372.66 |