| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,197 |
3,768 |
$192K |
| 92004 |
|
820 |
791 |
$105K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,015 |
1,822 |
$105K |
| 92002 |
|
1,109 |
1,014 |
$73K |
| 92015 |
|
4,418 |
4,075 |
$68K |
| 92014 |
|
642 |
618 |
$66K |
| 92012 |
|
620 |
582 |
$40K |
| V2755 |
U-v lens, per lens |
931 |
842 |
$24K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
166 |
139 |
$12K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
214 |
141 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
260 |
238 |
$10K |