| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
20,675 |
20,506 |
$642K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
29,122 |
17,498 |
$250K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
10,510 |
6,174 |
$92K |
| V2100 |
Lens spher single plano 4.00 |
9,171 |
6,403 |
$64K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
4,022 |
2,843 |
$41K |
| V2107 |
Spherocylinder 4.25d/12-2d |
3,031 |
2,031 |
$30K |
| V2200 |
Lens spher bifoc plano 4.00d |
1,913 |
1,464 |
$16K |
| V2303 |
Lens sphcy trifocal 4.0/.12- |
1,060 |
610 |
$15K |
| S0620 |
Routine ophthalmological exa |
66 |
66 |
$3K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
282 |
218 |
$3K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
272 |
199 |
$3K |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
262 |
189 |
$3K |
| V2207 |
Lens sphcy bifocal 4.25-7d/. |
87 |
56 |
$844.25 |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
66 |
38 |
$762.69 |
| 92340 |
|
30 |
30 |
$606.30 |
| V2715 |
Prism lens/es |
124 |
124 |
$350.70 |
| V2101 |
Single visn sphere 4.12-7.00 |
43 |
32 |
$344.11 |
| V2300 |
Lens sphere trifocal 4.00d |
17 |
13 |
$181.39 |