| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2499 |
Variable sphericity lens, other type |
428 |
394 |
$34K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,580 |
2,267 |
$33K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,535 |
2,232 |
$33K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,309 |
1,173 |
$15K |
| V2020 |
Frames, purchases |
2,567 |
2,257 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
624 |
565 |
$8K |
| V2204 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
54 |
43 |
$780.00 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
67 |
58 |
$636.40 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
16 |
13 |
$189.20 |
| V2106 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens |
13 |
12 |
$172.00 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
12 |
12 |
$172.00 |