| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
1,378 |
1,364 |
$136K |
| 92004 |
|
1,113 |
1,087 |
$130K |
| V2025 |
Eyeglasses delux frames |
1,730 |
1,708 |
$78K |
| V2100 |
Lens spher single plano 4.00 |
2,329 |
1,741 |
$51K |
| 92015 |
|
2,736 |
2,687 |
$41K |
| S0621 |
Routine ophthalmological exa |
340 |
335 |
$18K |
| V2020 |
Vision svcs frames purchases |
914 |
890 |
$18K |
| S0620 |
Routine ophthalmological exa |
275 |
274 |
$15K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
373 |
290 |
$8K |
| V2784 |
Lens polycarb or equal |
279 |
276 |
$5K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
196 |
161 |
$4K |
| 92060 |
|
25 |
24 |
$1K |
| 92250 |
|
24 |
24 |
$1K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
27 |
24 |
$770.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
28 |
24 |
$558.50 |
| V2200 |
Lens spher bifoc plano 4.00d |
16 |
13 |
$494.00 |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
17 |
12 |
$263.50 |
| V2750 |
Anti-reflective coating |
50 |
49 |
$32.34 |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
45 |
45 |
$0.00 |
| V2745 |
Tint, any color/solid/grad |
14 |
14 |
$0.00 |