| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
3,312 |
3,118 |
$290K |
| V2020 |
Frames, purchases |
5,466 |
5,120 |
$208K |
| 92004 |
|
1,173 |
1,126 |
$131K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,171 |
1,927 |
$102K |
| 92015 |
|
5,381 |
5,112 |
$79K |
| V2755 |
U-v lens, per lens |
3,056 |
2,891 |
$71K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
233 |
131 |
$9K |
| 92250 |
|
177 |
161 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
68 |
48 |
$2K |
| 99213 |
|
26 |
25 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
16 |
12 |
$575.29 |