| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,571 |
2,567 |
$60K |
| 92340 |
|
2,768 |
2,759 |
$60K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,521 |
1,306 |
$37K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,235 |
1,124 |
$36K |
| 92014 |
|
288 |
287 |
$28K |
| 67028 |
|
294 |
285 |
$22K |
| V2025 |
Deluxe frame |
581 |
579 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,373 |
854 |
$10K |
| 92012 |
|
109 |
98 |
$7K |
| 99214 |
|
64 |
64 |
$6K |
| 92134 |
|
164 |
161 |
$5K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
349 |
241 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
34 |
34 |
$2K |
| 92015 |
|
222 |
222 |
$935.28 |
| 99213 |
|
12 |
12 |
$687.66 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
91 |
64 |
$553.28 |