| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 67028 |
|
1,900 |
1,177 |
$82K |
| 92004 |
|
1,044 |
821 |
$63K |
| 92014 |
|
1,511 |
987 |
$57K |
| 92012 |
|
1,133 |
794 |
$51K |
| 92235 |
|
1,683 |
1,233 |
$33K |
| 99214 |
|
209 |
201 |
$26K |
| 92015 |
|
342 |
335 |
$25K |
| 92134 |
|
3,516 |
2,474 |
$20K |
| 76512 |
|
5,142 |
1,822 |
$18K |
| 92250 |
|
411 |
335 |
$4K |
| V2025 |
Deluxe frame |
144 |
140 |
$4K |
| 99204 |
|
34 |
28 |
$3K |
| J9035 |
Injection, bevacizumab, 10 mg |
194 |
141 |
$3K |
| V2020 |
Frames, purchases |
59 |
59 |
$2K |
| 76519 |
|
50 |
37 |
$2K |
| 92226 |
|
889 |
358 |
$783.22 |
| 92020 |
|
835 |
597 |
$427.99 |
| 92083 |
|
414 |
313 |
$271.75 |
| 92133 |
|
383 |
285 |
$164.78 |
| 92225 |
|
170 |
79 |
$81.51 |
| V2799 |
Vision item or service, miscellaneous |
96 |
48 |
$25.50 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
19 |
13 |
$0.00 |
| J3490 |
Unclassified drugs |
12 |
12 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
21 |
14 |
$0.00 |
| 92273 |
|
23 |
15 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
24 |
12 |
$0.00 |
| 92201 |
|
150 |
56 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
15 |
13 |
$0.00 |
| 92202 |
|
107 |
78 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
40 |
20 |
$0.00 |
| 92340 |
|
22 |
22 |
$0.00 |