| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92286 |
|
272 |
271 |
$24K |
| 92004 |
|
342 |
341 |
$23K |
| 92250 |
|
324 |
323 |
$16K |
| V2199 |
Not otherwise classified, single vision lens |
1,264 |
632 |
$7K |
| 92025 |
|
308 |
307 |
$7K |
| V2020 |
Frames, purchases |
1,485 |
1,477 |
$6K |
| 92340 |
|
418 |
417 |
$6K |
| 92285 |
|
216 |
216 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
263 |
247 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
214 |
126 |
$1K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
65 |
65 |
$1K |
| V2299 |
Specialty bifocal (by report) |
88 |
44 |
$514.44 |
| V2750 |
Anti-reflective coating, per lens |
531 |
268 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
647 |
326 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
88 |
44 |
$0.00 |