| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
2,228 |
2,176 |
$48K |
| V2020 |
Frames, purchases |
2,789 |
2,702 |
$45K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
2,066 |
2,013 |
$25K |
| V2781 |
Progressive lens, per lens |
133 |
133 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
191 |
182 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
70 |
67 |
$1K |
| S0506 |
Bifocal vision prescription lens (safety, athletic, or sunglass), per lens |
44 |
42 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
34 |
32 |
$755.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
45 |
44 |
$139.40 |