| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,824 |
967 |
$30K |
| V2020 |
Frames, purchases |
2,042 |
2,032 |
$22K |
| 92014 |
|
452 |
452 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
429 |
278 |
$3K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
117 |
117 |
$2K |
| 92340 |
|
141 |
141 |
$2K |
| 92004 |
|
17 |
17 |
$320.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
976 |
498 |
$302.00 |
| V2755 |
U-v lens, per lens |
672 |
335 |
$0.00 |