| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
3,001 |
2,880 |
$162K |
| 92015 |
|
3,964 |
3,816 |
$134K |
| 92004 |
|
1,070 |
1,017 |
$78K |
| 92340 |
|
2,615 |
2,551 |
$72K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
1,399 |
1,347 |
$47K |
| V2020 |
Frames, purchases |
2,058 |
1,981 |
$25K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
349 |
339 |
$5K |
| 92250 |
|
25 |
25 |
$787.07 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
67 |
67 |
$450.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
39 |
36 |
$119.00 |
| V2760 |
Scratch resistant coating, per lens |
30 |
28 |
$45.00 |