| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
266 |
248 |
$51K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
266 |
248 |
$21K |
| V2025 |
Deluxe frame |
266 |
248 |
$18K |
| V2750 |
Anti-reflective coating, per lens |
265 |
247 |
$8K |
| V2755 |
U-v lens, per lens |
266 |
248 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
114 |
102 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
267 |
248 |
$6K |