| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,344 |
1,264 |
$25K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,196 |
1,128 |
$18K |
| V2755 |
U-v lens, per lens |
869 |
409 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
447 |
275 |
$4K |
| V2750 |
Anti-reflective coating, per lens |
98 |
45 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
248 |
119 |
$2K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
102 |
60 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
44 |
25 |
$424.00 |