| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
4,038 |
3,583 |
$162K |
| 92340 |
|
4,350 |
3,843 |
$125K |
| 92015 |
|
6,167 |
5,508 |
$106K |
| 92004 |
|
2,184 |
1,915 |
$96K |
| V2020 |
Frames, purchases |
1,888 |
1,777 |
$31K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,969 |
1,709 |
$17K |
| 92012 |
|
375 |
364 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,839 |
1,601 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
355 |
308 |
$10K |
| 92250 |
|
38 |
26 |
$1K |
| V2025 |
Deluxe frame |
12 |
12 |
$479.10 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
80 |
54 |
$198.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$191.20 |