| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,395 |
2,350 |
$16K |
| 92004 |
|
601 |
591 |
$6K |
| 92201 |
|
1,031 |
926 |
$5K |
| 92260 |
|
257 |
221 |
$3K |
| 92015 |
|
2,140 |
2,038 |
$1K |
| V2020 |
Frames, purchases |
2,491 |
2,448 |
$24.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,625 |
1,298 |
$20.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,023 |
1,483 |
$0.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
254 |
127 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
24 |
12 |
$0.00 |
| V2760 |
Scratch resistant coating, per lens |
164 |
82 |
$0.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
12 |
$0.00 |