| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
26,907 |
19,226 |
$4.35M |
| V2025 |
Deluxe frame |
23,871 |
16,695 |
$2.45M |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
27,009 |
19,284 |
$929K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13,425 |
9,873 |
$719K |
| V2750 |
Anti-reflective coating, per lens |
26,999 |
19,269 |
$708K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
8,311 |
5,755 |
$557K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
26,948 |
19,227 |
$516K |
| V2730 |
Special base curve, glass or plastic, per lens |
13,245 |
7,512 |
$472K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
4,120 |
3,514 |
$188K |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
13,733 |
10,723 |
$180K |
| V2020 |
Frames, purchases |
3,151 |
2,705 |
$108K |
| V2780 |
Oversize lens, per lens |
402 |
221 |
$9K |
| V2430 |
Variable asphericity lens, bifocal, full field, glass or plastic, per lens |
60 |
60 |
$9K |
| V2781 |
Progressive lens, per lens |
15 |
15 |
$2K |
| V2219 |
Bifocal seg width over 28 mm |
15 |
15 |
$1K |
| 92341 |
|
58 |
58 |
$1K |
| V2204 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
15 |
15 |
$0.00 |