| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,418 |
2,366 |
$97K |
| 92340 |
|
3,153 |
2,990 |
$54K |
| 92015 |
|
3,819 |
3,665 |
$50K |
| 92004 |
|
512 |
497 |
$27K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,402 |
2,332 |
$18K |
| V2020 |
Frames, purchases |
2,734 |
2,643 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
927 |
903 |
$5K |
| 99214 |
|
75 |
71 |
$3K |
| 99213 |
|
90 |
78 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
779 |
759 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
27 |
27 |
$0.00 |