| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,597 |
2,175 |
$99K |
| 92014 |
|
960 |
887 |
$73K |
| 92015 |
|
2,486 |
2,267 |
$34K |
| 92004 |
|
350 |
336 |
$31K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
397 |
255 |
$12K |
| 92250 |
|
219 |
209 |
$7K |
| 99213 |
|
211 |
192 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
82 |
68 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
82 |
72 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
55 |
25 |
$1K |
| 99214 |
|
17 |
17 |
$725.51 |
| 92133 |
|
28 |
25 |
$514.67 |
| 92083 |
|
13 |
13 |
$274.66 |