| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
1,157 |
1,069 |
$73K |
| 92004 |
|
763 |
733 |
$66K |
| V2020 |
Frames, purchases |
1,952 |
1,835 |
$60K |
| 92340 |
|
1,711 |
1,618 |
$50K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,126 |
1,066 |
$21K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,373 |
1,292 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
524 |
490 |
$9K |
| 92015 |
|
1,518 |
1,430 |
$4K |
| V2760 |
Scratch resistant coating, per lens |
1,345 |
1,262 |
$3K |
| 99213 |
|
14 |
12 |
$554.86 |
| 92341 |
|
17 |
14 |
$495.00 |
| 92370 |
|
19 |
14 |
$380.40 |