| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92250 |
|
2,719 |
2,651 |
$118K |
| 92014 |
|
2,249 |
2,198 |
$106K |
| 92004 |
|
1,704 |
1,673 |
$88K |
| V2020 |
Vision svcs frames purchases |
4,972 |
4,898 |
$59K |
| V2100 |
Lens spher single plano 4.00 |
3,077 |
2,461 |
$47K |
| 92012 |
|
1,032 |
1,000 |
$42K |
| 92083 |
|
436 |
425 |
$22K |
| 92132 |
|
527 |
515 |
$13K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,008 |
1,122 |
$12K |
| 92226 |
|
722 |
353 |
$9K |
| 92285 |
|
184 |
175 |
$9K |
| 92133 |
|
272 |
262 |
$8K |
| V2200 |
Lens spher bifoc plano 4.00d |
398 |
268 |
$6K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
765 |
396 |
$4K |
| 92225 |
|
237 |
119 |
$3K |
| 99213 |
|
82 |
82 |
$3K |
| 92134 |
|
58 |
57 |
$2K |
| S0620 |
Routine ophthalmological exa |
80 |
80 |
$2K |
| S0621 |
Routine ophthalmological exa |
102 |
102 |
$1K |
| V2784 |
Lens polycarb or equal |
1,516 |
821 |
$677.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
60 |
32 |
$326.48 |
| V2107 |
Spherocylinder 4.25d/12-2d |
45 |
24 |
$283.98 |
| 76514 |
|
38 |
37 |
$241.12 |
| 92202 |
|
14 |
13 |
$104.93 |
| V2755 |
Uv lens/es |
976 |
487 |
$0.00 |
| 92015 |
|
587 |
556 |
$0.00 |