| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,338 |
2,251 |
$75K |
| V2020 |
Frames, purchases |
5,981 |
5,861 |
$21K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
6,323 |
3,972 |
$17K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
913 |
911 |
$16K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,721 |
1,144 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
373 |
190 |
$0.00 |