| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
756 |
642 |
$25K |
| 92014 |
|
1,469 |
1,466 |
$78.00 |
| 92015 |
|
888 |
886 |
$0.00 |
| V2520 |
Contact lens hydrophilic |
50 |
50 |
$0.00 |
| V2020 |
Vision svcs frames purchases |
2,742 |
2,717 |
$0.00 |
| V2500 |
Contact lens pmma spherical |
578 |
578 |
$0.00 |
| S0621 |
Routine ophthalmological exa |
46 |
46 |
$0.00 |
| V2750 |
Anti-reflective coating |
24 |
12 |
$0.00 |
| V2784 |
Lens polycarb or equal |
1,360 |
678 |
$0.00 |
| 92004 |
|
1,752 |
1,752 |
$0.00 |
| V2599 |
Contact lens/es other type |
99 |
99 |
$0.00 |
| V2100 |
Lens spher single plano 4.00 |
3,527 |
1,759 |
$0.00 |
| S0592 |
Comp cont lens eval |
28 |
28 |
$0.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
206 |
103 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
87 |
87 |
$0.00 |
| V2200 |
Lens spher bifoc plano 4.00d |
36 |
18 |
$0.00 |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
30 |
15 |
$0.00 |