| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
977 |
888 |
$70K |
| 92004 |
|
210 |
195 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
597 |
585 |
$13K |
| V2020 |
Frames, purchases |
1,113 |
1,077 |
$11K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
95 |
95 |
$8K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
302 |
295 |
$3K |
| 92340 |
|
868 |
852 |
$3K |
| 92015 |
|
1,084 |
1,031 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
126 |
126 |
$2K |
| 92250 |
|
88 |
77 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
17 |
15 |
$542.26 |
| 92341 |
|
14 |
12 |
$0.00 |