| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
638 |
638 |
$10K |
| 92004 |
|
543 |
543 |
$7K |
| V2020 |
Vision svcs frames purchases |
1,182 |
1,180 |
$6K |
| 92015 |
|
523 |
523 |
$2K |
| V2784 |
Lens polycarb or equal |
496 |
327 |
$1K |
| V2100 |
Lens spher single plano 4.00 |
436 |
288 |
$1K |
| V2200 |
Lens spher bifoc plano 4.00d |
314 |
203 |
$754.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
306 |
195 |
$588.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
225 |
138 |
$546.00 |
| V2599 |
Contact lens/es other type |
139 |
139 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
43 |
43 |
$0.00 |
| V2745 |
Tint, any color/solid/grad |
23 |
12 |
$0.00 |
| S0621 |
Routine ophthalmological exa |
95 |
95 |
$0.00 |