| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,422 |
2,387 |
$167K |
| 92004 |
|
1,511 |
1,488 |
$135K |
| V2020 |
Frames, purchases |
3,190 |
3,149 |
$86K |
| V2025 |
Deluxe frame |
1,360 |
1,341 |
$55K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,173 |
1,981 |
$44K |
| 92015 |
|
4,068 |
4,007 |
$26K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
604 |
580 |
$12K |
| V2756 |
Eye glass case |
3,291 |
3,230 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
67 |
64 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
15 |
14 |
$280.72 |