| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
5,943 |
5,632 |
$696K |
| V2020 |
Frames, purchases |
10,877 |
9,983 |
$482K |
| 92014 |
|
4,831 |
4,687 |
$481K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,933 |
4,610 |
$254K |
| 92015 |
|
12,093 |
11,534 |
$192K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,860 |
1,742 |
$86K |
| V2755 |
U-v lens, per lens |
2,686 |
2,481 |
$71K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
288 |
241 |
$44K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
248 |
217 |
$17K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
269 |
219 |
$10K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
96 |
91 |
$4K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
40 |
38 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
13 |
12 |
$733.04 |
| 92310 |
|
33 |
31 |
$300.00 |