| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,867 |
1,829 |
$30K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,485 |
720 |
$21K |
| 92002 |
|
446 |
445 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
278 |
138 |
$4K |
| 92012 |
|
94 |
94 |
$3K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
65 |
33 |
$979.28 |
| 92014 |
|
36 |
36 |
$415.00 |
| 92004 |
|
13 |
13 |
$120.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
770 |
380 |
$0.00 |
| V2755 |
U-v lens, per lens |
126 |
62 |
$0.00 |