| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
3,327 |
3,316 |
$77K |
| 92004 |
|
1,078 |
1,075 |
$24K |
| 92340 |
|
1,090 |
1,082 |
$18K |
| 92015 |
|
2,999 |
2,986 |
$9K |
| 99212 |
|
81 |
75 |
$2K |
| 92341 |
|
53 |
53 |
$920.00 |
| V2020 |
Frames, purchases |
1,698 |
1,663 |
$460.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
705 |
341 |
$83.60 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
116 |
60 |
$63.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
790 |
384 |
$21.00 |
| 2022F |
|
87 |
87 |
$0.00 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
38 |
38 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
12 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
18 |
18 |
$0.00 |
| 2023F |
|
42 |
41 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
40 |
26 |
$0.00 |