| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
3,341 |
3,220 |
$145K |
| V2750 |
Anti-reflective coating |
4,209 |
4,023 |
$113K |
| V2784 |
Lens polycarb or equal |
6,959 |
3,905 |
$104K |
| 92015 |
|
5,646 |
5,455 |
$104K |
| 92004 |
|
2,187 |
2,085 |
$98K |
| 92340 |
|
4,140 |
4,030 |
$84K |
| V2020 |
Vision svcs frames purchases |
4,444 |
4,357 |
$74K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
4,057 |
2,622 |
$26K |
| 92341 |
|
791 |
770 |
$19K |
| 99214 |
|
335 |
319 |
$16K |
| 99213 |
|
489 |
431 |
$16K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
943 |
645 |
$12K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
268 |
133 |
$7K |
| V2100 |
Lens spher single plano 4.00 |
1,005 |
793 |
$6K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
565 |
413 |
$3K |
| V2107 |
Spherocylinder 4.25d/12-2d |
448 |
300 |
$3K |
| 92083 |
|
125 |
120 |
$3K |
| 92250 |
|
90 |
81 |
$2K |
| 92342 |
|
55 |
52 |
$2K |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
30 |
29 |
$2K |
| 99212 |
|
27 |
26 |
$589.46 |
| V2744 |
Tint photochromatic lens/es |
97 |
49 |
$552.00 |
| V2303 |
Lens sphcy trifocal 4.0/.12- |
22 |
13 |
$377.72 |
| 99072 |
|
56 |
51 |
$33.00 |
| G9903 |
Pt scrn tbco id as non user |
3,137 |
3,046 |
$0.00 |
| 1036F |
|
3,500 |
3,385 |
$0.00 |
| G9902 |
Pt scrn tbco and id as user |
849 |
828 |
$0.00 |
| V2781 |
Progressive lens per lens |
73 |
37 |
$0.00 |
| G8397 |
Dil macula/fundus exam/w doc |
13 |
12 |
$0.00 |
| G8427 |
Docrev cur meds by elig clin |
4,314 |
4,154 |
$0.00 |
| 4004F |
|
849 |
826 |
$0.00 |
| G9905 |
No pt tbco scrn rng |
33 |
30 |
$0.00 |
| 2022F |
|
39 |
37 |
$0.00 |
| G8785 |
Bp scrn no perf at interval |
169 |
157 |
$0.00 |
| 5010F |
|
14 |
13 |
$0.00 |