| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0621 |
Routine ophthalmological exa |
9,061 |
8,938 |
$392K |
| 92012 |
|
4,252 |
4,127 |
$237K |
| V2020 |
Vision svcs frames purchases |
13,147 |
13,093 |
$235K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
16,005 |
8,903 |
$180K |
| 92014 |
|
1,596 |
1,574 |
$122K |
| S0620 |
Routine ophthalmological exa |
2,770 |
2,719 |
$119K |
| 92340 |
|
3,406 |
3,250 |
$97K |
| 92002 |
|
1,095 |
1,075 |
$64K |
| 92015 |
|
5,463 |
5,374 |
$57K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
3,596 |
2,246 |
$39K |
| V2100 |
Lens spher single plano 4.00 |
2,922 |
1,701 |
$33K |
| V2784 |
Lens polycarb or equal |
524 |
521 |
$12K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
273 |
156 |
$5K |
| V2107 |
Spherocylinder 4.25d/12-2d |
293 |
180 |
$3K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
32 |
25 |
$759.75 |