| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,338 |
1,315 |
$112K |
| V2020 |
Frames, purchases |
2,518 |
2,456 |
$71K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
345 |
330 |
$35K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
827 |
812 |
$31K |
| 92004 |
|
376 |
374 |
$20K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
310 |
302 |
$12K |
| V2755 |
U-v lens, per lens |
596 |
587 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
74 |
74 |
$5K |
| 92014 |
|
12 |
12 |
$605.33 |