| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
872 |
872 |
$59K |
| V2020 |
Frames, purchases |
1,349 |
1,349 |
$54K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
431 |
430 |
$14K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
102 |
102 |
$6K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
160 |
160 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
12 |
12 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
259 |
256 |
$523.60 |