| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
7,540 |
3,166 |
$160K |
| V2020 |
Frames, purchases |
4,018 |
3,361 |
$120K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,362 |
4,854 |
$117K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,223 |
1,647 |
$32K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
934 |
480 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
411 |
240 |
$5K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
41 |
24 |
$545.46 |
| V2025 |
Deluxe frame |
12 |
12 |
$18.95 |