| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,544 |
3,523 |
$152K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,641 |
1,374 |
$69K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,174 |
1,004 |
$58K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
161 |
145 |
$12K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
520 |
386 |
$9K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
44 |
43 |
$3K |