| Code | Description | Claims | Beneficiaries | Total Paid |
| 92004 |
|
6,075 |
5,268 |
$690K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
3,358 |
2,607 |
$461K |
| V2020 |
Frames, purchases |
3,626 |
2,773 |
$136K |
| 92014 |
|
1,365 |
1,191 |
$134K |
| V2755 |
U-v lens, per lens |
4,213 |
3,221 |
$119K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,314 |
1,813 |
$95K |
| V2750 |
Anti-reflective coating, per lens |
4,199 |
3,210 |
$94K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,206 |
3,220 |
$79K |
| 92340 |
|
3,504 |
2,742 |
$69K |
| V2025 |
Deluxe frame |
494 |
383 |
$55K |
| V2430 |
Variable asphericity lens, bifocal, full field, glass or plastic, per lens |
214 |
133 |
$32K |
| 92015 |
|
7,726 |
6,669 |
$31K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
278 |
197 |
$12K |
| 92341 |
|
269 |
168 |
$9K |
| 92250 |
|
57 |
53 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
68 |
55 |
$2K |
| 92012 |
|
29 |
26 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
75 |
40 |
$622.05 |