| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
462 |
411 |
$19K |
| 92004 |
|
319 |
278 |
$13K |
| V2020 |
Frames, purchases |
756 |
656 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
834 |
669 |
$10K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
586 |
474 |
$5K |
| 92015 |
|
803 |
705 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
277 |
231 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
18 |
15 |
$299.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$171.00 |