| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
5,422 |
4,639 |
$226K |
| V2020 |
Vision svcs frames purchases |
17,110 |
16,767 |
$175K |
| V2100 |
Lens spher single plano 4.00 |
14,387 |
7,868 |
$162K |
| 92002 |
|
2,376 |
2,373 |
$89K |
| 92250 |
|
1,828 |
1,817 |
$85K |
| 92340 |
|
4,917 |
4,884 |
$67K |
| 92014 |
|
1,791 |
1,400 |
$61K |
| 92012 |
|
1,116 |
1,113 |
$44K |
| V2200 |
Lens spher bifoc plano 4.00d |
2,544 |
1,311 |
$42K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
5,894 |
4,165 |
$38K |
| 92285 |
|
1,102 |
1,098 |
$29K |
| V2784 |
Lens polycarb or equal |
4,845 |
2,629 |
$21K |
| 92015 |
|
1,764 |
1,762 |
$20K |
| 92341 |
|
678 |
667 |
$13K |
| S0580 |
Polycarb lens |
860 |
858 |
$12K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,149 |
767 |
$12K |
| 92083 |
|
208 |
205 |
$10K |
| 92133 |
|
184 |
182 |
$5K |
| 76512 |
|
54 |
54 |
$4K |
| 76514 |
|
412 |
411 |
$3K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
592 |
373 |
$3K |
| 92082 |
|
64 |
64 |
$3K |
| 99203 |
|
46 |
46 |
$2K |
| V2107 |
Spherocylinder 4.25d/12-2d |
286 |
187 |
$2K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
32 |
32 |
$2K |
| V2112 |
Spherocylindr 7.25d/2.25-4d |
68 |
68 |
$1K |
| 92020 |
|
71 |
71 |
$1K |
| 99213 |
|
16 |
16 |
$578.62 |
| 92060 |
|
16 |
16 |
$564.16 |
| 92134 |
|
49 |
49 |
$421.63 |
| V2745 |
Tint, any color/solid/grad |
482 |
228 |
$0.00 |
| 92286 |
|
46 |
46 |
$0.00 |
| G8397 |
Dil macula/fundus exam/w doc |
89 |
58 |
$0.00 |