| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
1,522 |
1,421 |
$96K |
| V2020 |
Frames, purchases |
3,105 |
2,407 |
$84K |
| 92004 |
|
929 |
871 |
$77K |
| 92340 |
|
2,038 |
1,896 |
$61K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,376 |
1,804 |
$38K |
| 92370 |
|
1,010 |
926 |
$26K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,493 |
1,829 |
$18K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
828 |
657 |
$11K |
| V2760 |
Scratch resistant coating, per lens |
2,492 |
1,826 |
$4K |
| 92250 |
|
78 |
73 |
$3K |
| 92015 |
|
1,340 |
1,280 |
$402.42 |