| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
211 |
211 |
$10K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
59 |
59 |
$7K |
| V2020 |
Frames, purchases |
329 |
329 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
176 |
176 |
$5K |
| 92004 |
|
105 |
105 |
$5K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
101 |
101 |
$5K |
| 92015 |
|
217 |
217 |
$4K |
| 92340 |
|
141 |
141 |
$3K |
| 92341 |
|
65 |
65 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
102 |
102 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
145 |
145 |
$1K |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
91 |
91 |
$905.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
39 |
39 |
$322.24 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$64.68 |