| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,712 |
1,565 |
$103K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
809 |
771 |
$21K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
389 |
349 |
$18K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
182 |
175 |
$12K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
226 |
144 |
$10K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
192 |
180 |
$9K |
| 92341 |
|
291 |
251 |
$7K |
| V2756 |
Eye glass case |
2,288 |
2,135 |
$4K |