| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
876 |
602 |
$78K |
| 92004 |
|
344 |
305 |
$73K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
109 |
106 |
$12K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
585 |
353 |
$6K |
| V2020 |
Frames, purchases |
1,280 |
904 |
$5K |
| 92340 |
|
1,195 |
839 |
$3K |
| 92014 |
|
24 |
15 |
$2K |
| 92015 |
|
569 |
506 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
116 |
59 |
$0.00 |