| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
6,259 |
6,208 |
$157K |
| 92004 |
|
2,433 |
2,421 |
$55K |
| 92340 |
|
2,138 |
2,130 |
$29K |
| 92012 |
|
303 |
277 |
$16K |
| 92015 |
|
4,575 |
4,561 |
$14K |
| 99214 |
|
275 |
264 |
$14K |
| 92250 |
|
49 |
48 |
$1K |
| V2020 |
Vision svcs frames purchases |
3,095 |
3,070 |
$1K |
| 99213 |
|
17 |
16 |
$680.00 |
| V2100 |
Lens spher single plano 4.00 |
1,316 |
1,089 |
$318.88 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,300 |
810 |
$0.00 |
| V2784 |
Lens polycarb or equal |
1,578 |
1,090 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
79 |
49 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
57 |
57 |
$0.00 |
| V2200 |
Lens spher bifoc plano 4.00d |
163 |
99 |
$0.00 |
| V2781 |
Progressive lens per lens |
24 |
12 |
$0.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
442 |
259 |
$0.00 |
| V2760 |
Scratch resistant coating |
133 |
80 |
$0.00 |
| S0621 |
Routine ophthalmological exa |
359 |
359 |
$0.00 |
| 2025F |
|
15 |
15 |
$0.00 |