| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,519 |
1,450 |
$99K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
1,428 |
1,368 |
$37K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
247 |
242 |
$11K |
| V2730 |
Special base curve, glass or plastic, per lens |
424 |
411 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
44 |
44 |
$2K |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
26 |
26 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
13 |
13 |
$375.00 |
| V2780 |
Oversize lens, per lens |
12 |
12 |
$105.00 |