| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
483 |
477 |
$13K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
385 |
381 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
333 |
330 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
247 |
246 |
$2K |
| 92341 |
|
15 |
15 |
$361.65 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
15 |
15 |
$300.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$177.97 |