| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
636 |
598 |
$75K |
| V2020 |
Frames, purchases |
936 |
900 |
$68K |
| 92014 |
|
212 |
208 |
$22K |
| 92340 |
|
649 |
623 |
$20K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
304 |
205 |
$13K |
| 92015 |
|
755 |
721 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
251 |
152 |
$9K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
191 |
163 |
$7K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
109 |
107 |
$5K |
| 92081 |
|
68 |
67 |
$2K |
| 92134 |
|
32 |
31 |
$943.83 |