| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
3,328 |
3,320 |
$167K |
| V2020 |
Vision svcs frames purchases |
12,390 |
12,301 |
$68K |
| V2784 |
Lens polycarb or equal |
8,833 |
5,044 |
$40K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
9,626 |
5,590 |
$29K |
| 92004 |
|
431 |
429 |
$21K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
3,780 |
2,303 |
$20K |
| V2520 |
Contact lens hydrophilic |
299 |
299 |
$16K |
| 92015 |
|
3,951 |
3,936 |
$16K |
| V2100 |
Lens spher single plano 4.00 |
2,924 |
1,726 |
$7K |
| 92340 |
|
232 |
232 |
$4K |
| 92250 |
|
112 |
111 |
$3K |
| V2107 |
Spherocylinder 4.25d/12-2d |
455 |
230 |
$105.00 |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
31 |
16 |
$21.00 |
| V2744 |
Tint photochromatic lens/es |
254 |
126 |
$0.00 |
| V2599 |
Contact lens/es other type |
75 |
75 |
$0.00 |
| V2299 |
Lens bifocal speciality |
28 |
14 |
$0.00 |
| V2781 |
Progressive lens per lens |
99 |
51 |
$0.00 |
| V2200 |
Lens spher bifoc plano 4.00d |
24 |
12 |
$0.00 |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
24 |
12 |
$0.00 |
| V2500 |
Contact lens pmma spherical |
86 |
86 |
$0.00 |
| V2750 |
Anti-reflective coating |
394 |
196 |
$0.00 |