| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,980 |
5,963 |
$257K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,200 |
3,195 |
$166K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,406 |
1,401 |
$76K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
2,018 |
2,017 |
$40K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
285 |
284 |
$23K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
164 |
161 |
$10K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
25 |
25 |
$1K |