| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
14,557 |
14,491 |
$1.15M |
| 92083 |
|
17,478 |
17,397 |
$876K |
| 92250 |
|
19,023 |
18,966 |
$856K |
| 92014 |
|
13,104 |
13,093 |
$848K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
20,879 |
12,188 |
$403K |
| 68761 |
|
2,458 |
1,228 |
$217K |
| V2020 |
Frames, purchases |
12,880 |
12,817 |
$210K |
| 92012 |
|
3,628 |
3,551 |
$174K |
| 68840 |
|
1,950 |
1,040 |
$160K |
| 92133 |
|
4,929 |
4,914 |
$154K |
| 76512 |
|
2,273 |
1,316 |
$153K |
| 92002 |
|
902 |
900 |
$34K |
| 92015 |
|
2,620 |
2,600 |
$30K |
| 92340 |
|
917 |
917 |
$14K |
| 92134 |
|
409 |
409 |
$13K |
| 92202 |
|
456 |
236 |
$7K |
| 92225 |
|
474 |
238 |
$7K |
| 92020 |
|
168 |
168 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
312 |
156 |
$2K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
24 |
12 |
$492.40 |
| 67820 |
|
13 |
12 |
$337.39 |
| 76514 |
|
15 |
15 |
$138.39 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
89 |
45 |
$70.00 |