| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
366 |
314 |
$0.00 |
| 92004 |
|
386 |
383 |
$0.00 |
| V2781 |
Progressive lens, per lens |
212 |
211 |
$0.00 |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
74 |
74 |
$0.00 |
| V2521 |
Contact lens, hydrophilic, toric, or prism ballast, per lens |
70 |
70 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
298 |
296 |
$0.00 |
| V2299 |
Specialty bifocal (by report) |
214 |
212 |
$0.00 |
| 92015 |
|
1,409 |
1,372 |
$0.00 |
| V2020 |
Frames, purchases |
711 |
708 |
$0.00 |
| 92014 |
|
1,246 |
1,242 |
$0.00 |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
341 |
339 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
236 |
180 |
$0.00 |