| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,340 |
1,974 |
$65K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,262 |
1,114 |
$61K |
| 92002 |
|
1,298 |
1,287 |
$52K |
| 92012 |
|
233 |
231 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
263 |
142 |
$7K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
100 |
54 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
25 |
12 |
$912.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
432 |
217 |
$566.00 |
| V2744 |
Tint, photochromatic, per lens |
24 |
12 |
$15.00 |
| V2781 |
Progressive lens, per lens |
50 |
25 |
$0.00 |
| 92015 |
|
58 |
58 |
$0.00 |