| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,213 |
1,182 |
$22K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
871 |
848 |
$21K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
946 |
920 |
$19K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
529 |
517 |
$6K |
| 92341 |
|
191 |
184 |
$5K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
27 |
27 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$145.92 |