| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
18,039 |
16,585 |
$392K |
| 92340 |
|
4,718 |
4,679 |
$87K |
| 99214 |
|
1,397 |
1,365 |
$58K |
| 92004 |
|
3,023 |
3,006 |
$41K |
| 92015 |
|
10,192 |
10,136 |
$21K |
| 99215 |
Prolong outpt/office vis |
41 |
41 |
$3K |
| V2020 |
Vision svcs frames purchases |
11,232 |
11,069 |
$3K |
| V2100 |
Lens spher single plano 4.00 |
14,108 |
7,920 |
$2K |
| V2784 |
Lens polycarb or equal |
13,085 |
7,103 |
$2K |
| V2300 |
Lens sphere trifocal 4.00d |
56 |
56 |
$39.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,736 |
915 |
$34.00 |
| 2022F |
|
195 |
187 |
$0.00 |
| S0621 |
Routine ophthalmological exa |
222 |
222 |
$0.00 |
| V2750 |
Anti-reflective coating |
47 |
25 |
$0.00 |
| V2200 |
Lens spher bifoc plano 4.00d |
361 |
212 |
$0.00 |
| 2023F |
|
58 |
56 |
$0.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
340 |
173 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
156 |
82 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
79 |
79 |
$0.00 |
| V2781 |
Progressive lens per lens |
158 |
77 |
$0.00 |
| V2299 |
Lens bifocal speciality |
26 |
16 |
$0.00 |