| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
8,673 |
8,333 |
$255K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
5,595 |
5,441 |
$111K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,187 |
2,150 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,073 |
1,055 |
$25K |
| V2025 |
Deluxe frame |
290 |
287 |
$19K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
51 |
49 |
$935.00 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
15 |
15 |
$375.98 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
31 |
31 |
$26.00 |
| 99199 |
Unlisted special service, procedure or report |
15 |
15 |
$0.00 |