| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
1,001 |
990 |
$301K |
| 92004 |
|
5,585 |
5,484 |
$224K |
| 92014 |
|
6,655 |
6,436 |
$216K |
| V2020 |
Vision svcs frames purchases |
18,593 |
17,874 |
$203K |
| V2100 |
Lens spher single plano 4.00 |
11,920 |
7,212 |
$176K |
| V2200 |
Lens spher bifoc plano 4.00d |
3,962 |
2,549 |
$82K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
8,097 |
5,355 |
$73K |
| 92340 |
|
4,036 |
3,944 |
$53K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
3,357 |
2,333 |
$52K |
| 92341 |
|
1,714 |
1,677 |
$30K |
| 92015 |
|
6,987 |
6,807 |
$25K |
| S0580 |
Polycarb lens |
1,076 |
1,066 |
$14K |
| V2784 |
Lens polycarb or equal |
9,420 |
5,275 |
$12K |
| 92012 |
|
151 |
146 |
$5K |
| 92226 |
|
427 |
383 |
$5K |
| 92225 |
|
383 |
356 |
$5K |
| V2107 |
Spherocylinder 4.25d/12-2d |
483 |
290 |
$4K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
390 |
242 |
$3K |
| 99212 |
|
148 |
147 |
$3K |
| 92060 |
|
104 |
102 |
$2K |
| S0621 |
Routine ophthalmological exa |
96 |
95 |
$2K |
| 92201 |
|
105 |
96 |
$2K |
| 92202 |
|
153 |
136 |
$1K |
| S0620 |
Routine ophthalmological exa |
59 |
59 |
$1K |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
21 |
13 |
$264.00 |
| 99211 |
|
14 |
14 |
$188.88 |
| V2745 |
Tint, any color/solid/grad |
1,872 |
930 |
$91.80 |
| 2022F |
|
27 |
26 |
$0.00 |
| V2755 |
Uv lens/es |
6,144 |
3,025 |
$0.00 |
| 3072F |
|
13 |
13 |
$0.00 |