| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
20 |
19 |
$715.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
18 |
16 |
$693.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
148 |
84 |
$201.20 |
| V2020 |
Frames, purchases |
387 |
284 |
$0.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
106 |
83 |
$0.00 |
| V2756 |
Eye glass case |
362 |
288 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
22 |
15 |
$0.00 |