| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
335 |
329 |
$3K |
| V2760 |
Scratch resistant coating, per lens |
324 |
319 |
$3K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
174 |
170 |
$3K |
| V2755 |
U-v lens, per lens |
325 |
320 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
61 |
58 |
$840.00 |
| 92341 |
|
40 |
39 |
$693.79 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$234.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
32 |
30 |
$128.00 |