| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
9,364 |
8,672 |
$388K |
| 92004 |
|
6,931 |
6,654 |
$297K |
| 92340 |
|
12,283 |
12,167 |
$189K |
| V2020 |
Vision svcs frames purchases |
12,710 |
12,514 |
$108K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
1,959 |
1,914 |
$99K |
| V2100 |
Lens spher single plano 4.00 |
3,490 |
3,408 |
$56K |
| 92015 |
|
2,694 |
2,561 |
$39K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
6,104 |
6,047 |
$21K |
| V2200 |
Lens spher bifoc plano 4.00d |
267 |
264 |
$10K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
946 |
933 |
$7K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
1,534 |
1,522 |
$3K |
| V2107 |
Spherocylinder 4.25d/12-2d |
394 |
390 |
$1K |
| 92250 |
|
12 |
12 |
$309.89 |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
26 |
26 |
$100.00 |
| V2784 |
Lens polycarb or equal |
4,689 |
4,646 |
$35.00 |
| V2025 |
Eyeglasses delux frames |
106 |
106 |
$0.00 |