| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
3,229 |
3,196 |
$145K |
| 92014 |
|
1,815 |
1,806 |
$104K |
| 92004 |
|
1,232 |
1,225 |
$88K |
| V2020 |
Frames, purchases |
3,122 |
3,094 |
$60K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,978 |
1,492 |
$47K |
| V2500 |
Contact lens, pmma, spherical, per lens |
96 |
96 |
$40K |
| 99204 |
|
249 |
247 |
$22K |
| 68761 |
|
287 |
144 |
$21K |
| 99214 |
|
331 |
317 |
$20K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
586 |
297 |
$13K |
| 92285 |
|
428 |
426 |
$12K |
| 92083 |
|
133 |
129 |
$7K |
| 68801 |
|
87 |
44 |
$5K |
| 92012 |
|
40 |
40 |
$2K |
| 92020 |
|
120 |
120 |
$2K |
| 92060 |
|
34 |
34 |
$1K |
| 92341 |
|
26 |
26 |
$460.00 |
| 99213 |
|
12 |
12 |
$438.95 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,266 |
628 |
$430.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$276.00 |
| 92225 |
|
23 |
13 |
$268.86 |
| V2755 |
U-v lens, per lens |
632 |
316 |
$0.00 |