| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Lens spher single plano 4.00 |
13,092 |
7,601 |
$209K |
| V2020 |
Vision svcs frames purchases |
11,911 |
11,665 |
$176K |
| 92014 |
|
3,435 |
3,415 |
$108K |
| V2200 |
Lens spher bifoc plano 4.00d |
3,283 |
1,957 |
$72K |
| 92004 |
|
574 |
573 |
$11K |
| V2784 |
Lens polycarb or equal |
10,622 |
5,588 |
$10K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,385 |
731 |
$9K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
464 |
251 |
$4K |
| 92340 |
|
304 |
301 |
$1K |
| 92341 |
|
67 |
65 |
$740.00 |
| 92002 |
|
16 |
16 |
$625.20 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
83 |
44 |
$370.64 |
| S0621 |
Routine ophthalmological exa |
13 |
13 |
$240.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
20 |
12 |
$81.08 |
| V2755 |
Uv lens/es |
5,417 |
2,660 |
$0.00 |
| V2745 |
Tint, any color/solid/grad |
120 |
60 |
$0.00 |
| 92015 |
|
57 |
56 |
$0.00 |
| V2750 |
Anti-reflective coating |
24 |
12 |
$0.00 |