| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
8,351 |
8,214 |
$718K |
| 92014 |
|
5,263 |
5,215 |
$357K |
| 92340 |
|
12,184 |
12,001 |
$213K |
| V2020 |
Frames, purchases |
12,927 |
12,736 |
$178K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
22,931 |
12,306 |
$176K |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
7,208 |
7,094 |
$151K |
| 92015 |
|
13,708 |
13,517 |
$120K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16,577 |
9,080 |
$93K |
| 92370 |
|
4,151 |
3,986 |
$21K |
| V2755 |
U-v lens, per lens |
2,088 |
2,070 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,418 |
984 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
957 |
603 |
$6K |
| 99212 |
|
139 |
128 |
$4K |
| 92341 |
|
183 |
177 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
173 |
92 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
123 |
78 |
$935.76 |