| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
5,604 |
5,344 |
$25K |
| 92004 |
|
5,251 |
5,086 |
$17K |
| V2020 |
Vision svcs frames purchases |
10,912 |
10,416 |
$17K |
| 92340 |
|
1,172 |
1,064 |
$15K |
| V2100 |
Lens spher single plano 4.00 |
16,357 |
8,813 |
$14K |
| V2200 |
Lens spher bifoc plano 4.00d |
1,041 |
634 |
$4K |
| 92015 |
|
1,098 |
913 |
$3K |
| 92310 |
|
433 |
407 |
$1K |
| 92341 |
|
56 |
54 |
$760.00 |
| 92250 |
|
3,169 |
2,929 |
$272.98 |
| V2784 |
Lens polycarb or equal |
4,566 |
2,363 |
$266.00 |
| V2300 |
Lens sphere trifocal 4.00d |
110 |
66 |
$78.00 |
| V2755 |
Uv lens/es |
2,177 |
1,042 |
$0.00 |
| S0500 |
Dispos cont lens |
367 |
364 |
$0.00 |
| V2781 |
Progressive lens per lens |
66 |
40 |
$0.00 |
| V2799 |
Misc vision item or service |
328 |
205 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
107 |
48 |
$0.00 |
| V2750 |
Anti-reflective coating |
3,075 |
1,544 |
$0.00 |
| 92201 |
|
111 |
106 |
$0.00 |
| V2797 |
Vis item/svc in other code |
15 |
15 |
$0.00 |
| V2500 |
Contact lens pmma spherical |
16 |
16 |
$0.00 |