| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
20,450 |
20,388 |
$1.39M |
| 92250 |
|
14,011 |
13,974 |
$686K |
| 92340 |
|
35,209 |
35,128 |
$466K |
| 92014 |
|
7,686 |
7,640 |
$440K |
| V2100 |
Lens spher single plano 4.00 |
34,630 |
34,546 |
$308K |
| 92015 |
|
25,810 |
25,758 |
$306K |
| 92002 |
|
6,794 |
6,775 |
$252K |
| 92083 |
|
4,654 |
4,626 |
$242K |
| S0580 |
Polycarb lens |
14,834 |
14,798 |
$233K |
| V2020 |
Vision svcs frames purchases |
42,034 |
42,023 |
$225K |
| V2200 |
Lens spher bifoc plano 4.00d |
11,634 |
11,613 |
$215K |
| 92341 |
|
11,349 |
11,332 |
$183K |
| 92012 |
|
4,506 |
4,371 |
$178K |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
1,028 |
1,024 |
$152K |
| 99204 |
|
1,775 |
1,774 |
$145K |
| 92285 |
|
7,566 |
7,473 |
$99K |
| 76512 |
|
1,240 |
1,216 |
$97K |
| 68761 |
|
649 |
646 |
$64K |
| 92060 |
|
1,478 |
1,477 |
$57K |
| 92286 |
|
629 |
611 |
$50K |
| 99214 |
|
807 |
783 |
$43K |
| 92133 |
|
1,415 |
1,398 |
$42K |
| 92082 |
|
611 |
611 |
$28K |
| 99213 |
|
533 |
449 |
$21K |
| V2112 |
Spherocylindr 7.25d/2.25-4d |
1,905 |
1,904 |
$21K |
| 92225 |
|
1,020 |
1,017 |
$19K |
| 92025 |
|
647 |
614 |
$14K |
| 92202 |
|
1,309 |
1,305 |
$13K |
| 92134 |
|
342 |
324 |
$11K |
| 76514 |
|
1,090 |
1,059 |
$9K |
| 92020 |
|
606 |
605 |
$8K |
| 92201 |
|
411 |
411 |
$8K |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
610 |
609 |
$6K |
| 92132 |
|
249 |
241 |
$5K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
110 |
110 |
$3K |
| 99203 |
|
29 |
29 |
$2K |
| 92226 |
|
64 |
64 |
$1K |
| 92081 |
|
12 |
12 |
$364.06 |
| V2114 |
Spherocylinder over 12.00d |
19 |
19 |
$190.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
14 |
14 |
$0.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
140 |
139 |
$0.00 |