| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
993 |
820 |
$70K |
| V2020 |
Frames, purchases |
2,274 |
1,962 |
$67K |
| 92015 |
|
2,522 |
2,196 |
$57K |
| 92340 |
|
1,737 |
1,510 |
$30K |
| 92012 |
|
402 |
375 |
$27K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
813 |
657 |
$18K |
| 92004 |
|
200 |
156 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
383 |
263 |
$8K |
| 92002 |
|
31 |
29 |
$2K |
| 92083 |
|
43 |
32 |
$2K |
| 92250 |
|
31 |
29 |
$1K |
| 92341 |
|
48 |
48 |
$637.45 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
15 |
13 |
$434.01 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
54 |
53 |
$248.90 |
| 2023F |
|
32 |
31 |
$0.00 |