| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,840 |
2,732 |
$211K |
| 92004 |
|
1,443 |
1,385 |
$139K |
| S0621 |
Routine ophthalmological exa |
2,875 |
2,783 |
$117K |
| S0620 |
Routine ophthalmological exa |
2,186 |
2,084 |
$87K |
| V2020 |
Vision svcs frames purchases |
3,653 |
3,348 |
$64K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
2,207 |
2,015 |
$41K |
| 92015 |
|
2,753 |
2,623 |
$37K |
| 92012 |
|
390 |
347 |
$20K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
479 |
415 |
$7K |
| V2744 |
Tint photochromatic lens/es |
183 |
178 |
$7K |
| V2100 |
Lens spher single plano 4.00 |
301 |
278 |
$5K |
| V2750 |
Anti-reflective coating |
161 |
155 |
$4K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
142 |
136 |
$3K |
| 92083 |
|
66 |
64 |
$3K |
| V2025 |
Eyeglasses delux frames |
24 |
24 |
$1K |
| 92133 |
|
25 |
24 |
$731.06 |
| V2784 |
Lens polycarb or equal |
92 |
89 |
$683.09 |
| V2200 |
Lens spher bifoc plano 4.00d |
13 |
13 |
$185.14 |