| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
533 |
533 |
$54K |
| V2020 |
Frames, purchases |
1,203 |
1,183 |
$52K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
252 |
194 |
$10K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
273 |
270 |
$4K |
| 92004 |
|
25 |
25 |
$3K |
| 92015 |
|
185 |
185 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
41 |
41 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
63 |
63 |
$2K |
| 92012 |
|
24 |
24 |
$2K |