| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,792 |
2,351 |
$218K |
| V2020 |
Frames, purchases |
4,264 |
3,651 |
$155K |
| 92004 |
|
779 |
666 |
$75K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,501 |
1,285 |
$66K |
| 92015 |
|
5,375 |
4,476 |
$64K |
| V2755 |
U-v lens, per lens |
2,193 |
1,889 |
$41K |
| 92250 |
|
1,039 |
893 |
$24K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
104 |
96 |
$8K |
| 99214 |
|
56 |
43 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
66 |
52 |
$3K |
| 99213 |
|
20 |
13 |
$1K |