| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
11,230 |
10,187 |
$492K |
| 92340 |
|
12,981 |
11,983 |
$367K |
| 92014 |
|
6,159 |
5,621 |
$263K |
| V2025 |
Eyeglasses delux frames |
7,470 |
6,929 |
$246K |
| 92015 |
|
17,317 |
15,873 |
$245K |
| V2020 |
Vision svcs frames purchases |
6,090 |
5,746 |
$116K |
| V2100 |
Lens spher single plano 4.00 |
4,065 |
3,729 |
$74K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
4,889 |
4,483 |
$62K |
| 92012 |
|
638 |
565 |
$29K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
2,180 |
1,989 |
$26K |
| S0621 |
Routine ophthalmological exa |
546 |
541 |
$24K |
| V2784 |
Lens polycarb or equal |
2,284 |
2,172 |
$23K |
| V2200 |
Lens spher bifoc plano 4.00d |
421 |
400 |
$15K |
| S0620 |
Routine ophthalmological exa |
291 |
290 |
$13K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
325 |
315 |
$5K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
246 |
227 |
$4K |
| V2107 |
Spherocylinder 4.25d/12-2d |
289 |
263 |
$4K |
| V2799 |
Misc vision item or service |
18 |
18 |
$599.40 |
| 92310 |
|
12 |
12 |
$464.20 |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
12 |
12 |
$128.62 |
| V2750 |
Anti-reflective coating |
44 |
42 |
$0.00 |
| V2760 |
Scratch resistant coating |
47 |
39 |
$0.00 |