| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
5,012 |
5,004 |
$230K |
| V2020 |
Frames, purchases |
7,484 |
6,836 |
$159K |
| 92340 |
|
5,706 |
5,116 |
$127K |
| 92014 |
|
2,292 |
2,291 |
$110K |
| 92015 |
|
7,374 |
7,367 |
$72K |
| 92341 |
|
1,275 |
1,266 |
$42K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
249 |
247 |
$22K |
| 92250 |
|
366 |
365 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
71 |
71 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$624.96 |