| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
1,178 |
1,178 |
$24K |
| 92014 |
|
393 |
393 |
$22K |
| V2020 |
Frames, purchases |
1,284 |
1,284 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
809 |
697 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
662 |
493 |
$11K |
| 92015 |
|
875 |
875 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
196 |
169 |
$4K |
| V2599 |
Contact lens, other type |
24 |
24 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
246 |
123 |
$0.00 |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
136 |
136 |
$0.00 |