| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
929 |
830 |
$137K |
| 92014 |
|
1,359 |
1,305 |
$136K |
| 92004 |
|
669 |
629 |
$79K |
| V2020 |
Frames, purchases |
1,098 |
994 |
$50K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,145 |
1,017 |
$37K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
633 |
570 |
$29K |
| 92340 |
|
724 |
689 |
$14K |
| V2750 |
Anti-reflective coating, per lens |
214 |
179 |
$3K |
| 92015 |
|
1,870 |
1,799 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
40 |
37 |
$2K |
| 92370 |
|
32 |
28 |
$587.23 |
| V2744 |
Tint, photochromatic, per lens |
17 |
13 |
$489.28 |