| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
5,083 |
4,964 |
$168K |
| V2020 |
Frames, purchases |
3,449 |
2,829 |
$125K |
| 92004 |
|
1,963 |
1,937 |
$83K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,597 |
1,022 |
$71K |
| 99214 |
|
1,749 |
1,669 |
$47K |
| 92134 |
|
1,245 |
1,157 |
$23K |
| V2750 |
Anti-reflective coating, per lens |
908 |
400 |
$21K |
| 92083 |
|
447 |
442 |
$19K |
| 92133 |
|
646 |
634 |
$14K |
| 67028 |
|
127 |
115 |
$10K |
| 92250 |
|
149 |
149 |
$5K |
| 92015 |
|
959 |
945 |
$4K |
| 99213 |
|
197 |
178 |
$3K |
| 66984 |
|
13 |
12 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,642 |
1,348 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
82 |
38 |
$3K |
| 99204 |
|
29 |
29 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
60 |
25 |
$2K |
| V2744 |
Tint, photochromatic, per lens |
54 |
27 |
$2K |
| V2781 |
Progressive lens, per lens |
24 |
12 |
$1K |
| V2299 |
Specialty bifocal (by report) |
24 |
12 |
$896.16 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
28 |
13 |
$735.24 |
| 92025 |
|
38 |
37 |
$641.02 |
| 76519 |
|
12 |
12 |
$369.58 |
| 92012 |
|
14 |
13 |
$330.86 |
| 92020 |
|
15 |
15 |
$224.80 |