| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
952 |
950 |
$9K |
| 92250 |
|
180 |
179 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
698 |
349 |
$6K |
| 92285 |
|
172 |
171 |
$6K |
| 92004 |
|
86 |
86 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
330 |
198 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
320 |
160 |
$3K |
| 92012 |
|
46 |
44 |
$2K |
| 92014 |
|
37 |
37 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$452.40 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
662 |
340 |
$112.00 |