| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
12,143 |
11,361 |
$528K |
| 92340 |
|
18,724 |
17,635 |
$519K |
| 92004 |
|
10,106 |
9,238 |
$450K |
| V2025 |
Eyeglasses delux frames |
12,413 |
11,665 |
$418K |
| 92015 |
|
20,886 |
19,656 |
$347K |
| V2100 |
Lens spher single plano 4.00 |
6,982 |
6,353 |
$222K |
| 92012 |
|
1,792 |
1,586 |
$81K |
| 92341 |
|
2,590 |
2,428 |
$74K |
| V2784 |
Lens polycarb or equal |
9,449 |
9,052 |
$73K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,190 |
4,960 |
$70K |
| V2020 |
Vision svcs frames purchases |
4,642 |
4,381 |
$59K |
| V2200 |
Lens spher bifoc plano 4.00d |
805 |
739 |
$40K |
| 92310 |
|
733 |
684 |
$32K |
| V2410 |
Lens variab asphericity sing |
919 |
918 |
$27K |
| V2523 |
Cntct lens hydrophil extend |
243 |
219 |
$24K |
| S0621 |
Routine ophthalmological exa |
376 |
374 |
$17K |
| S0620 |
Routine ophthalmological exa |
248 |
243 |
$11K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
898 |
866 |
$11K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
382 |
364 |
$7K |
| V2107 |
Spherocylinder 4.25d/12-2d |
422 |
409 |
$5K |
| V2599 |
Contact lens/es other type |
26 |
26 |
$3K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
73 |
72 |
$967.40 |
| 2023F |
|
95 |
94 |
$0.00 |
| 3072F |
|
70 |
70 |
$0.00 |