| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
485 |
449 |
$12K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
382 |
340 |
$7K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
221 |
196 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
125 |
120 |
$4K |
| 92341 |
|
107 |
104 |
$2K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
46 |
40 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
34 |
33 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
34 |
31 |
$842.40 |