| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92012 |
|
2,930 |
2,709 |
$100K |
| 92014 |
|
1,533 |
1,521 |
$78K |
| 92083 |
|
1,659 |
1,643 |
$72K |
| V2020 |
Frames, purchases |
808 |
789 |
$61K |
| 92250 |
|
1,245 |
1,236 |
$54K |
| 92134 |
|
803 |
795 |
$25K |
| 92133 |
|
665 |
662 |
$23K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
754 |
436 |
$23K |
| 92004 |
|
318 |
313 |
$21K |
| 92015 |
|
1,309 |
1,304 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
157 |
156 |
$11K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
63 |
38 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
39 |
26 |
$1K |
| V2025 |
Deluxe frame |
27 |
27 |
$0.00 |