| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
|
936 |
931 |
$22K |
| V2020 |
Vision svcs frames purchases |
3,447 |
3,428 |
$11K |
| V2100 |
Lens spher single plano 4.00 |
2,282 |
1,488 |
$8K |
| 92002 |
|
790 |
787 |
$7K |
| V2784 |
Lens polycarb or equal |
1,768 |
1,163 |
$4K |
| V2200 |
Lens spher bifoc plano 4.00d |
209 |
158 |
$2K |
| 92015 |
|
569 |
568 |
$2K |
| 92004 |
|
519 |
519 |
$389.20 |
| 92014 |
|
461 |
461 |
$166.80 |
| V2520 |
Contact lens hydrophilic |
12 |
12 |
$100.00 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,563 |
987 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
78 |
78 |
$0.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
28 |
14 |
$0.00 |
| V2523 |
Cntct lens hydrophil extend |
57 |
56 |
$0.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
670 |
468 |
$0.00 |
| S0621 |
Routine ophthalmological exa |
56 |
56 |
$0.00 |