| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,404 |
2,275 |
$73K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,339 |
2,203 |
$59K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
788 |
785 |
$28K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,417 |
1,342 |
$25K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,629 |
1,505 |
$9K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
170 |
169 |
$2K |
| A6412 |
Eye patch, occlusive, each |
12 |
12 |
$465.92 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
12 |
$133.40 |