| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
8,917 |
8,807 |
$252K |
| 92340 |
|
7,547 |
7,440 |
$211K |
| 99214 |
|
1,286 |
1,220 |
$149K |
| 0402T |
|
29 |
29 |
$97K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,170 |
3,548 |
$72K |
| 92004 |
|
543 |
542 |
$68K |
| V2784 |
Lens polycarb or equal |
9,715 |
5,553 |
$54K |
| V2100 |
Lens spher single plano 4.00 |
2,026 |
1,773 |
$51K |
| J2787 |
Riboflavin 5'phos opth<=3ml |
27 |
27 |
$49K |
| V2025 |
Eyeglasses delux frames |
863 |
854 |
$40K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
2,431 |
1,721 |
$33K |
| 99213 |
|
387 |
357 |
$30K |
| 92014 |
|
277 |
275 |
$30K |
| V2200 |
Lens spher bifoc plano 4.00d |
521 |
493 |
$24K |
| 92341 |
|
539 |
536 |
$21K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
755 |
554 |
$16K |
| 92136 |
|
331 |
330 |
$15K |
| 92025 |
|
390 |
389 |
$13K |
| 92133 |
|
170 |
170 |
$7K |
| 92015 |
|
757 |
755 |
$4K |
| 92083 |
|
65 |
64 |
$4K |
| V2299 |
Lens bifocal speciality |
15 |
13 |
$1K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
102 |
79 |
$840.98 |
| V2107 |
Spherocylinder 4.25d/12-2d |
64 |
46 |
$426.11 |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
27 |
24 |
$249.31 |
| V2744 |
Tint photochromatic lens/es |
24 |
24 |
$0.00 |
| V2750 |
Anti-reflective coating |
167 |
164 |
$0.00 |
| V2760 |
Scratch resistant coating |
12 |
12 |
$0.00 |