| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
3,290 |
3,288 |
$381K |
| 92014 |
|
3,037 |
3,026 |
$307K |
| V2020 |
Vision svcs frames purchases |
9,983 |
9,966 |
$281K |
| 92340 |
|
7,513 |
7,468 |
$145K |
| V2100 |
Lens spher single plano 4.00 |
3,726 |
3,311 |
$108K |
| V2784 |
Lens polycarb or equal |
8,581 |
6,045 |
$104K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,065 |
4,059 |
$96K |
| V2025 |
Eyeglasses delux frames |
1,616 |
1,601 |
$60K |
| 92012 |
|
633 |
633 |
$46K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,645 |
1,365 |
$32K |
| V2200 |
Lens spher bifoc plano 4.00d |
594 |
573 |
$30K |
| 92015 |
|
4,531 |
4,527 |
$14K |
| 92341 |
|
326 |
326 |
$13K |
| 99213 |
|
183 |
175 |
$13K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
504 |
345 |
$7K |
| 99214 |
|
46 |
44 |
$5K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
190 |
153 |
$4K |
| V2107 |
Spherocylinder 4.25d/12-2d |
247 |
184 |
$4K |
| 92133 |
|
59 |
58 |
$2K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
83 |
70 |
$750.46 |
| V2715 |
Prism lens/es |
292 |
146 |
$627.80 |
| V2744 |
Tint photochromatic lens/es |
106 |
106 |
$320.00 |
| 2023F |
|
13 |
13 |
$0.00 |
| 3072F |
|
14 |
14 |
$0.00 |
| V2750 |
Anti-reflective coating |
115 |
115 |
$0.00 |