| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
|
1,134 |
1,129 |
$15K |
| V2020 |
Frames, purchases |
1,794 |
1,789 |
$14K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
481 |
479 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
490 |
364 |
$8K |
| V2199 |
Not otherwise classified, single vision lens |
454 |
227 |
$4K |
| 92341 |
|
102 |
102 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
879 |
460 |
$2K |
| V2299 |
Specialty bifocal (by report) |
142 |
71 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
90 |
90 |
$851.40 |
| 92004 |
|
33 |
33 |
$440.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$248.30 |
| V2760 |
Scratch resistant coating, per lens |
54 |
27 |
$140.00 |
| 92012 |
|
16 |
16 |
$0.00 |
| V2755 |
U-v lens, per lens |
778 |
389 |
$0.00 |
| 92002 |
|
12 |
12 |
$0.00 |