| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
2,678 |
2,542 |
$117K |
| 99213 |
|
1,461 |
1,459 |
$34K |
| 92004 |
|
875 |
861 |
$32K |
| 92014 |
|
338 |
337 |
$10K |
| 99212 |
|
660 |
655 |
$9K |
| 92012 |
|
152 |
150 |
$3K |
| 92285 |
|
605 |
559 |
$3K |
| V2020 |
Frames, purchases |
521 |
484 |
$2K |
| 92002 |
|
54 |
54 |
$1K |
| 92015 |
|
1,003 |
956 |
$985.23 |
| 92340 |
|
194 |
178 |
$466.25 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
86 |
39 |
$187.66 |
| 92132 |
|
35 |
35 |
$166.78 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
39 |
24 |
$133.58 |
| V2106 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens |
19 |
12 |
$66.08 |
| 76514 |
|
33 |
33 |
$55.04 |
| 92341 |
|
94 |
90 |
$40.00 |
| V2760 |
Scratch resistant coating, per lens |
196 |
86 |
$10.00 |
| V2750 |
Anti-reflective coating, per lens |
145 |
60 |
$0.00 |
| 92025 |
|
57 |
57 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
37 |
13 |
$0.00 |