| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,784 |
2,757 |
$19K |
| V2020 |
Vision svcs frames purchases |
5,745 |
5,677 |
$16K |
| 92004 |
|
2,505 |
2,482 |
$13K |
| V2200 |
Lens spher bifoc plano 4.00d |
1,625 |
1,343 |
$8K |
| V2100 |
Lens spher single plano 4.00 |
4,274 |
3,264 |
$8K |
| V2784 |
Lens polycarb or equal |
2,405 |
1,780 |
$6K |
| V2520 |
Contact lens hydrophilic |
202 |
202 |
$4K |
| 92225 |
|
202 |
143 |
$3K |
| 92015 |
|
3,049 |
2,996 |
$2K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
831 |
658 |
$2K |
| 92250 |
|
97 |
88 |
$2K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
926 |
691 |
$1K |
| V2750 |
Anti-reflective coating |
36 |
18 |
$0.00 |
| S0500 |
Dispos cont lens |
80 |
76 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
87 |
87 |
$0.00 |
| V2756 |
Eye glass case |
22 |
22 |
$0.00 |
| V2599 |
Contact lens/es other type |
250 |
250 |
$0.00 |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
63 |
58 |
$0.00 |
| 92285 |
|
20 |
20 |
$0.00 |
| 92002 |
|
13 |
13 |
$0.00 |
| 2023F |
|
17 |
13 |
$0.00 |
| 92283 |
|
12 |
12 |
$0.00 |