| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
|
1,640 |
1,507 |
$55K |
| 92014 |
|
726 |
668 |
$33K |
| V2020 |
Frames, purchases |
899 |
820 |
$23K |
| 92004 |
|
258 |
236 |
$15K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
359 |
337 |
$5K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
45 |
43 |
$1K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
37 |
36 |
$530.64 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
17 |
16 |
$456.30 |