| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
6,863 |
6,817 |
$157K |
| S0620 |
Routine ophthalmological exa |
3,328 |
3,317 |
$119K |
| S0621 |
Routine ophthalmological exa |
3,094 |
3,082 |
$111K |
| 92340 |
|
5,866 |
5,822 |
$93K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,914 |
2,869 |
$31K |
| V2100 |
Lens spher single plano 4.00 |
2,643 |
2,619 |
$25K |
| 92341 |
|
843 |
840 |
$15K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
452 |
434 |
$6K |
| V2784 |
Lens polycarb or equal |
1,070 |
1,065 |
$6K |
| V2200 |
Lens spher bifoc plano 4.00d |
229 |
226 |
$4K |
| 99213 |
|
77 |
69 |
$3K |
| 92004 |
|
28 |
28 |
$2K |
| 92014 |
|
31 |
31 |
$2K |
| 99212 |
|
62 |
60 |
$2K |
| 92015 |
|
75 |
75 |
$565.59 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
70 |
70 |
$507.57 |
| V2107 |
Spherocylinder 4.25d/12-2d |
27 |
27 |
$126.75 |
| V2744 |
Tint photochromatic lens/es |
62 |
60 |
$37.62 |
| V2781 |
Progressive lens per lens |
38 |
37 |
$0.00 |
| V2750 |
Anti-reflective coating |
202 |
198 |
$0.00 |