| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
36,376 |
29,776 |
$939K |
| V2100 |
Lens spher single plano 4.00 |
42,126 |
15,006 |
$873K |
| 92014 |
|
28,190 |
27,823 |
$698K |
| 92004 |
|
15,966 |
15,759 |
$439K |
| V2750 |
Anti-reflective coating |
18,133 |
7,596 |
$203K |
| 92012 |
|
5,163 |
4,616 |
$191K |
| V2744 |
Tint photochromatic lens/es |
8,745 |
4,320 |
$97K |
| V2299 |
Lens bifocal speciality |
5,439 |
2,660 |
$96K |
| V2200 |
Lens spher bifoc plano 4.00d |
4,660 |
2,381 |
$94K |
| V2781 |
Progressive lens per lens |
5,906 |
2,907 |
$81K |
| V2784 |
Lens polycarb or equal |
44,358 |
16,307 |
$47K |
| 92340 |
|
2,493 |
2,484 |
$43K |
| 92015 |
|
6,837 |
6,775 |
$29K |
| 92250 |
|
622 |
593 |
$25K |
| 92083 |
|
559 |
530 |
$19K |
| 92341 |
|
994 |
988 |
$17K |
| 92133 |
|
385 |
375 |
$10K |
| 99204 |
|
140 |
140 |
$9K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
12,738 |
6,601 |
$8K |
| 99214 |
|
204 |
204 |
$6K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
4,501 |
2,372 |
$5K |
| S0620 |
Routine ophthalmological exa |
124 |
124 |
$1K |
| S0621 |
Routine ophthalmological exa |
325 |
322 |
$1K |
| V2500 |
Contact lens pmma spherical |
25 |
25 |
$1K |
| 92310 |
|
14 |
14 |
$840.00 |
| 76514 |
|
64 |
61 |
$633.82 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
587 |
302 |
$557.94 |
| V2755 |
Uv lens/es |
215 |
213 |
$370.00 |
| V2520 |
Contact lens hydrophilic |
25 |
25 |
$200.00 |
| V2745 |
Tint, any color/solid/grad |
130 |
124 |
$65.50 |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
25 |
13 |
$0.00 |
| 3072F |
|
23 |
20 |
$0.00 |