| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
674 |
617 |
$14K |
| V2020 |
Frames, purchases |
723 |
664 |
$10K |
| V2760 |
Scratch resistant coating, per lens |
669 |
615 |
$9K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
112 |
106 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
275 |
207 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
83 |
66 |
$995.60 |
| 92370 |
|
17 |
13 |
$377.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
15 |
12 |
$142.80 |