| Code | Description | Claims | Bene. Records | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,672 |
2,525 |
$113K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,933 |
1,876 |
$63K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
717 |
655 |
$16K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
105 |
85 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
75 |
66 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
45 |
41 |
$1K |
| V2760 |
Scratch resistant coating, per lens |
88 |
86 |
$526.12 |
| V2025 |
Deluxe frame |
71 |
70 |
$520.00 |
| 92341 |
|
16 |
12 |
$363.10 |