| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
3,378 |
3,370 |
$100K |
| 92004 |
|
1,077 |
1,074 |
$50K |
| V2784 |
Lens polycarb or equal |
9,147 |
4,572 |
$30K |
| V2020 |
Vision svcs frames purchases |
8,605 |
8,225 |
$30K |
| 92225 |
|
1,031 |
521 |
$12K |
| 92015 |
|
1,334 |
1,333 |
$12K |
| 92226 |
|
934 |
473 |
$6K |
| 92083 |
|
209 |
209 |
$2K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
6,735 |
3,244 |
$2K |
| V2100 |
Lens spher single plano 4.00 |
2,528 |
1,308 |
$2K |
| 99204 |
|
25 |
25 |
$2K |
| 92012 |
|
75 |
71 |
$1K |
| 92020 |
|
233 |
233 |
$846.36 |
| 68761 |
|
12 |
12 |
$623.72 |
| 92202 |
|
61 |
60 |
$346.83 |
| G9903 |
Pt scrn tbco id as non user |
93 |
90 |
$0.00 |
| V2200 |
Lens spher bifoc plano 4.00d |
24 |
12 |
$0.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
320 |
160 |
$0.00 |
| S0620 |
Routine ophthalmological exa |
35 |
35 |
$0.00 |
| 1036F |
|
105 |
104 |
$0.00 |
| V2744 |
Tint photochromatic lens/es |
34 |
13 |
$0.00 |
| 2023F |
|
13 |
12 |
$0.00 |
| G8427 |
Docrev cur meds by elig clin |
83 |
82 |
$0.00 |
| S0621 |
Routine ophthalmological exa |
74 |
74 |
$0.00 |
| V2750 |
Anti-reflective coating |
126 |
55 |
$0.00 |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
122 |
57 |
$0.00 |