| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92015 |
|
5,431 |
4,768 |
$179K |
| V2020 |
Frames, purchases |
5,409 |
4,699 |
$156K |
| 92012 |
|
2,183 |
2,009 |
$146K |
| 92014 |
|
1,769 |
1,541 |
$130K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,656 |
2,472 |
$79K |
| 92340 |
|
5,038 |
4,412 |
$79K |
| 92002 |
|
925 |
842 |
$57K |
| 92004 |
|
508 |
443 |
$50K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,728 |
1,547 |
$44K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,302 |
2,553 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
89 |
69 |
$3K |
| 92341 |
|
141 |
124 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
45 |
41 |
$1K |
| 92250 |
|
31 |
24 |
$952.34 |
| 2026F |
|
153 |
148 |
$100.00 |
| 3072F |
|
34 |
27 |
$10.04 |
| 2033F |
|
30 |
27 |
$0.00 |