| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
6,925 |
6,916 |
$116K |
| 92225 |
|
1,788 |
1,786 |
$67K |
| 92340 |
|
1,738 |
1,735 |
$34K |
| 92283 |
|
1,772 |
1,771 |
$32K |
| 92004 |
|
1,405 |
1,404 |
$23K |
| 92015 |
|
4,292 |
4,278 |
$11K |
| V2020 |
Vision svcs frames purchases |
5,555 |
5,539 |
$11K |
| V2100 |
Lens spher single plano 4.00 |
3,804 |
3,337 |
$8K |
| 99214 |
|
166 |
164 |
$8K |
| V2784 |
Lens polycarb or equal |
2,916 |
2,048 |
$6K |
| V2200 |
Lens spher bifoc plano 4.00d |
970 |
850 |
$3K |
| 92285 |
|
13 |
13 |
$235.60 |
| S0621 |
Routine ophthalmological exa |
371 |
371 |
$79.20 |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,278 |
687 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
103 |
103 |
$0.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
91 |
52 |
$0.00 |
| 92012 |
|
13 |
13 |
$0.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
346 |
193 |
$0.00 |
| V2107 |
Spherocylinder 4.25d/12-2d |
24 |
12 |
$0.00 |