| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,651 |
1,635 |
$51K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
582 |
450 |
$24K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
418 |
320 |
$24K |
| 92341 |
|
1,010 |
1,001 |
$20K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,270 |
1,266 |
$19K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
76 |
54 |
$2K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
79 |
78 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
397 |
196 |
$0.00 |