| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,351 |
1,647 |
$66K |
| V2020 |
Frames, purchases |
4,545 |
4,436 |
$49K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,078 |
526 |
$21K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
485 |
242 |
$13K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
331 |
165 |
$6K |
| 92341 |
|
297 |
297 |
$6K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
273 |
269 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
8,896 |
4,350 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
74 |
37 |
$1K |