| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
974 |
949 |
$39K |
| 92004 |
|
747 |
737 |
$33K |
| V2020 |
Frames, purchases |
1,512 |
1,489 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,127 |
1,106 |
$25K |
| 92015 |
|
502 |
482 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
694 |
684 |
$7K |
| 92340 |
|
339 |
327 |
$7K |
| 92250 |
|
40 |
39 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
49 |
49 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
27 |
27 |
$1K |
| 92341 |
|
17 |
13 |
$350.61 |