| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
1,827 |
1,757 |
$153K |
| 92004 |
|
1,457 |
1,394 |
$149K |
| 92250 |
|
2,782 |
2,656 |
$141K |
| V2020 |
Frames, purchases |
1,607 |
1,574 |
$66K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,946 |
1,827 |
$36K |
| 92015 |
|
3,514 |
3,345 |
$35K |
| 92025 |
|
1,250 |
1,182 |
$32K |
| V2025 |
Deluxe frame |
418 |
393 |
$15K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
612 |
566 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
54 |
54 |
$2K |
| 92012 |
|
12 |
12 |
$781.48 |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
12 |
12 |
$590.27 |