| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,430 |
3,100 |
$119K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,593 |
1,428 |
$70K |
| V2755 |
U-v lens, per lens |
2,417 |
2,172 |
$38K |
| V2730 |
Special base curve, glass or plastic, per lens |
329 |
283 |
$9K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
106 |
92 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
37 |
36 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
32 |
31 |
$1K |