| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
11,912 |
11,455 |
$341K |
| 92340 |
|
10,581 |
10,204 |
$234K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
6,376 |
6,147 |
$172K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
8,463 |
8,197 |
$119K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,224 |
1,150 |
$39K |
| 92341 |
|
1,167 |
1,113 |
$28K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,040 |
986 |
$21K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
920 |
889 |
$21K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
215 |
209 |
$5K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
13 |
12 |
$1K |
| 92015 |
|
14 |
14 |
$204.20 |