| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,732 |
4,075 |
$131K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,153 |
2,721 |
$70K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,177 |
2,054 |
$68K |
| 92370 |
|
2,446 |
2,250 |
$63K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,458 |
3,817 |
$40K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
964 |
842 |
$23K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
305 |
265 |
$7K |
| V2760 |
Scratch resistant coating, per lens |
2,844 |
2,707 |
$5K |
| V2201 |
Sphere, bifocal, plus or minus 4.12 to plus or minus 7.00d, per lens |
72 |
64 |
$1K |
| 92341 |
|
19 |
18 |
$590.00 |