| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
4,977 |
4,916 |
$181K |
| 92004 |
|
2,510 |
2,469 |
$163K |
| 92083 |
|
3,836 |
3,795 |
$146K |
| 92014 |
|
2,957 |
2,936 |
$136K |
| 68761 |
|
1,148 |
616 |
$63K |
| V2020 |
Frames, purchases |
3,924 |
3,810 |
$45K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,744 |
880 |
$30K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
912 |
822 |
$18K |
| 92341 |
|
834 |
781 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
533 |
352 |
$8K |
| 92285 |
|
984 |
979 |
$8K |
| 92225 |
|
608 |
602 |
$8K |
| 92133 |
|
297 |
296 |
$6K |
| 68040 |
|
327 |
320 |
$4K |
| 92015 |
|
296 |
296 |
$4K |
| 92012 |
|
97 |
92 |
$3K |
| 92340 |
|
136 |
135 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
26 |
13 |
$514.44 |
| 92134 |
|
44 |
44 |
$412.74 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
864 |
425 |
$0.00 |