| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99204 |
|
7,862 |
7,858 |
$695K |
| 99214 |
|
10,245 |
10,105 |
$677K |
| V2020 |
Vision svcs frames purchases |
18,256 |
18,196 |
$497K |
| 92014 |
|
7,518 |
7,506 |
$475K |
| 92340 |
|
20,504 |
20,394 |
$399K |
| 92015 |
|
27,852 |
27,767 |
$306K |
| 92250 |
|
14,047 |
14,014 |
$293K |
| 92012 |
|
4,433 |
4,314 |
$204K |
| 92083 |
|
4,379 |
4,351 |
$138K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
11,772 |
8,210 |
$124K |
| V2100 |
Lens spher single plano 4.00 |
7,180 |
6,443 |
$119K |
| 99203 |
|
1,567 |
1,567 |
$97K |
| 99213 |
|
1,818 |
1,777 |
$86K |
| 92341 |
|
3,811 |
3,794 |
$85K |
| 92133 |
|
2,790 |
2,778 |
$50K |
| S0620 |
Routine ophthalmological exa |
1,056 |
1,055 |
$50K |
| V2784 |
Lens polycarb or equal |
11,393 |
11,345 |
$27K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
2,642 |
1,814 |
$25K |
| S0621 |
Routine ophthalmological exa |
499 |
499 |
$25K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,967 |
1,548 |
$22K |
| V2200 |
Lens spher bifoc plano 4.00d |
707 |
652 |
$15K |
| 92004 |
|
163 |
161 |
$13K |
| 92342 |
|
319 |
317 |
$8K |
| V2781 |
Progressive lens per lens |
587 |
456 |
$6K |
| 99215 |
Prolong outpt/office vis |
28 |
28 |
$3K |
| 76514 |
|
434 |
433 |
$3K |
| V2107 |
Spherocylinder 4.25d/12-2d |
252 |
179 |
$2K |
| 92134 |
|
106 |
106 |
$2K |
| V2025 |
Eyeglasses delux frames |
69 |
69 |
$1K |
| V2744 |
Tint photochromatic lens/es |
408 |
407 |
$847.40 |
| V2750 |
Anti-reflective coating |
1,159 |
1,150 |
$27.48 |
| 2023F |
|
566 |
562 |
$0.00 |
| 99072 |
|
308 |
305 |
$0.00 |