| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,198 |
2,162 |
$65K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,758 |
1,729 |
$43K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,154 |
1,140 |
$19K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,385 |
1,363 |
$11K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
438 |
431 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
245 |
240 |
$6K |
| 92370 |
|
93 |
92 |
$3K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
80 |
80 |
$1K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
45 |
45 |
$650.00 |