| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
10,595 |
10,054 |
$180K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
11,690 |
11,038 |
$151K |
| V2020 |
Frames, purchases |
13,084 |
12,395 |
$151K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
649 |
649 |
$36K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
961 |
898 |
$17K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
468 |
457 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
55 |
55 |
$860.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
457 |
457 |
$63.00 |