| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,146 |
1,072 |
$30K |
| V2020 |
Frames, purchases |
1,173 |
1,098 |
$23K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,081 |
1,007 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
775 |
724 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
89 |
84 |
$811.43 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$0.00 |