| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 99214 |
|
658 |
601 |
$49K |
| V2020 |
Frames, purchases |
1,388 |
1,268 |
$35K |
| 92250 |
|
1,000 |
888 |
$34K |
| 92015 |
|
1,268 |
1,150 |
$29K |
| 99213 |
|
642 |
557 |
$27K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
531 |
497 |
$16K |
| 92285 |
|
1,001 |
884 |
$15K |
| 92340 |
|
584 |
559 |
$8K |
| 99204 |
|
54 |
40 |
$5K |
| 99211 |
|
226 |
197 |
$2K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
63 |
61 |
$2K |
| 92133 |
|
87 |
80 |
$2K |
| 92083 |
|
83 |
79 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
29 |
24 |
$973.64 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
53 |
42 |
$892.69 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
253 |
231 |
$450.12 |
| 92134 |
|
43 |
43 |
$249.04 |
| 76514 |
|
12 |
12 |
$141.52 |