| Code | Description | Claims | Beneficiaries | Total Paid |
| 92014 |
|
4,499 |
4,195 |
$184K |
| 92004 |
|
3,120 |
2,830 |
$137K |
| 92015 |
|
7,395 |
6,915 |
$120K |
| 92340 |
|
4,070 |
3,899 |
$114K |
| 92341 |
|
1,805 |
1,690 |
$50K |
| 92012 |
|
806 |
434 |
$36K |
| V2025 |
Deluxe frame |
703 |
610 |
$23K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
404 |
348 |
$15K |
| V2020 |
Frames, purchases |
471 |
437 |
$14K |
| S0621 |
Routine ophthalmological examination including refraction; established patient |
105 |
104 |
$5K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
98 |
98 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
394 |
389 |
$3K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
21 |
21 |
$975.45 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
86 |
86 |
$146.74 |
| V2715 |
Prism, per lens |
25 |
25 |
$0.00 |