| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
278 |
257 |
$13K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
298 |
240 |
$7K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
29 |
29 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
12 |
$413.50 |
| V2020 |
Frames, purchases |
1,112 |
1,034 |
$316.00 |
| V2755 |
U-v lens, per lens |
522 |
521 |
$184.50 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
13 |
13 |
$146.00 |
| 92341 |
|
163 |
154 |
$75.09 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
60 |
54 |
$50.55 |