| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
6,980 |
6,973 |
$65K |
| 99213 |
|
1,900 |
1,731 |
$56K |
| V2020 |
Vision svcs frames purchases |
8,196 |
8,154 |
$25K |
| 92004 |
|
2,668 |
2,663 |
$21K |
| V2100 |
Lens spher single plano 4.00 |
6,795 |
3,980 |
$20K |
| V2784 |
Lens polycarb or equal |
7,409 |
4,013 |
$8K |
| 92015 |
|
2,298 |
2,294 |
$7K |
| V2200 |
Lens spher bifoc plano 4.00d |
932 |
579 |
$5K |
| 92083 |
|
164 |
162 |
$3K |
| 92133 |
|
47 |
47 |
$1K |
| 99214 |
|
30 |
30 |
$900.00 |
| 92250 |
|
42 |
42 |
$760.00 |
| 92012 |
|
13 |
12 |
$429.00 |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
168 |
85 |
$102.60 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
3,157 |
1,666 |
$36.00 |
| V2744 |
Tint photochromatic lens/es |
884 |
439 |
$0.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
104 |
52 |
$0.00 |
| 2033F |
|
769 |
751 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
133 |
133 |
$0.00 |
| V2781 |
Progressive lens per lens |
75 |
38 |
$0.00 |
| V2299 |
Lens bifocal speciality |
28 |
14 |
$0.00 |
| V2760 |
Scratch resistant coating |
3,956 |
2,005 |
$0.00 |
| V2750 |
Anti-reflective coating |
4,075 |
2,069 |
$0.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
457 |
230 |
$0.00 |
| S0621 |
Routine ophthalmological exa |
152 |
152 |
$0.00 |