| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
3,250 |
3,031 |
$139K |
| 92015 |
|
5,198 |
4,799 |
$92K |
| 92004 |
|
1,818 |
1,652 |
$83K |
| 92340 |
|
2,794 |
2,539 |
$81K |
| V2025 |
Deluxe frame |
1,504 |
1,407 |
$53K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,715 |
2,493 |
$43K |
| V2020 |
Frames, purchases |
2,134 |
1,942 |
$20K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,274 |
2,075 |
$18K |
| 92341 |
|
344 |
297 |
$10K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
294 |
267 |
$8K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
145 |
128 |
$2K |
| 92250 |
|
21 |
13 |
$747.81 |