| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
1,213 |
1,158 |
$74K |
| 92004 |
|
903 |
848 |
$68K |
| 92340 |
|
2,895 |
2,542 |
$46K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,367 |
2,187 |
$31K |
| V2020 |
Frames, purchases |
2,538 |
2,255 |
$30K |
| V2499 |
Variable sphericity lens, other type |
877 |
350 |
$29K |
| V2750 |
Anti-reflective coating, per lens |
397 |
342 |
$29K |
| 92015 |
|
2,462 |
2,340 |
$20K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,622 |
876 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,426 |
771 |
$8K |
| 92083 |
|
52 |
49 |
$2K |
| 92250 |
|
55 |
50 |
$2K |
| S9999 |
Sales tax |
105 |
96 |
$0.00 |