| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
222 |
196 |
$15K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
217 |
194 |
$1K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
12 |
$80.36 |
| V2755 |
U-v lens, per lens |
209 |
183 |
$76.18 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
89 |
87 |
$30.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
48 |
41 |
$9.00 |
| V2750 |
Anti-reflective coating, per lens |
58 |
41 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
13 |
13 |
$0.00 |