| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,322 |
623 |
$40K |
| 92014 |
|
578 |
563 |
$26K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
468 |
190 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
777 |
382 |
$14K |
| V2020 |
Frames, purchases |
1,001 |
878 |
$7K |
| 92015 |
|
1,191 |
1,165 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
198 |
85 |
$3K |
| 92012 |
|
31 |
31 |
$911.71 |