| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
1,980 |
1,925 |
$129K |
| 92004 |
|
1,092 |
1,049 |
$95K |
| V2020 |
Frames, purchases |
3,276 |
2,912 |
$78K |
| 92340 |
|
2,222 |
2,155 |
$69K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,824 |
1,729 |
$28K |
| 92015 |
|
974 |
955 |
$16K |
| 92341 |
|
458 |
432 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,898 |
1,790 |
$13K |
| 92002 |
|
173 |
172 |
$9K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
349 |
326 |
$5K |
| 92012 |
|
110 |
110 |
$5K |
| V2760 |
Scratch resistant coating, per lens |
1,569 |
1,520 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
127 |
124 |
$2K |
| 99212 |
|
52 |
38 |
$1K |
| S0516 |
Safety eyeglass frames |
50 |
50 |
$799.00 |
| S0504 |
Single vision prescription lens (safety, athletic, or sunglass), per lens |
51 |
50 |
$472.86 |
| 92370 |
|
14 |
13 |
$377.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
15 |
15 |
$130.00 |
| S9999 |
Sales tax |
79 |
77 |
$124.92 |