| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92341 |
|
2,983 |
2,843 |
$63K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,824 |
2,709 |
$35K |
| V2755 |
U-v lens, per lens |
2,828 |
2,708 |
$29K |
| V2025 |
Deluxe frame |
2,702 |
2,578 |
$26K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,875 |
1,793 |
$23K |
| V2780 |
Oversize lens, per lens |
1,823 |
1,750 |
$10K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
581 |
555 |
$7K |
| V2020 |
Frames, purchases |
490 |
470 |
$5K |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
1,863 |
1,787 |
$5K |
| 92342 |
|
25 |
24 |
$288.20 |
| V2303 |
Spherocylinder, trifocal, plano to plus or minus 4.00d sphere, .12-2.00d cylinder, per lens |
14 |
13 |
$199.50 |