| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,293 |
1,207 |
$51K |
| V2760 |
Scratch resistant coating, per lens |
1,280 |
1,194 |
$19K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
360 |
336 |
$14K |
| 92014 |
|
202 |
193 |
$13K |
| 92015 |
|
1,511 |
1,385 |
$8K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
625 |
591 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
115 |
104 |
$5K |
| 92012 |
|
68 |
65 |
$3K |
| 92004 |
|
15 |
13 |
$1K |
| 99214 |
|
18 |
12 |
$251.56 |