| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
2,515 |
2,204 |
$134K |
| 92014 |
|
1,887 |
1,756 |
$85K |
| V2020 |
Vision svcs frames purchases |
3,087 |
2,706 |
$40K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
1,499 |
1,349 |
$33K |
| 92015 |
|
3,755 |
3,452 |
$21K |
| 92340 |
|
2,604 |
2,309 |
$20K |
| V2100 |
Lens spher single plano 4.00 |
588 |
515 |
$11K |
| V2314 |
Lens sphcyl trifocal over 12 |
411 |
321 |
$6K |
| 92341 |
|
660 |
608 |
$5K |
| V2025 |
Eyeglasses delux frames |
605 |
568 |
$3K |
| V2313 |
Lens sphc trifo 7.25-12/4.25 |
261 |
238 |
$1K |
| V2784 |
Lens polycarb or equal |
100 |
93 |
$308.24 |
| 92082 |
|
16 |
13 |
$120.00 |
| V2213 |
Lens sphcyl bifo 7.25-12/4.2 |
66 |
43 |
$56.12 |
| V2114 |
Spherocylinder over 12.00d |
33 |
22 |
$0.00 |
| V2214 |
Lens sphcyl bifocal over 12. |
51 |
30 |
$0.00 |
| V2113 |
Spherocylindr 7.25d/4.25-6d |
33 |
22 |
$0.00 |