| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,042 |
3,636 |
$126K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,473 |
1,283 |
$57K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
795 |
656 |
$47K |
| 92341 |
|
1,466 |
1,358 |
$39K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,391 |
1,305 |
$34K |
| V2204 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
370 |
248 |
$17K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
383 |
366 |
$14K |
| V2206 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens |
32 |
14 |
$1K |
| V2106 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, over 6.00d cylinder, per lens |
30 |
14 |
$806.80 |
| V2025 |
Deluxe frame |
299 |
297 |
$275.00 |
| V2760 |
Scratch resistant coating, per lens |
36 |
17 |
$122.82 |
| V2756 |
Eye glass case |
39 |
38 |
$57.00 |
| V2799 |
Vision item or service, miscellaneous |
78 |
64 |
$15.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
147 |
147 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
418 |
418 |
$0.00 |
| 92342 |
|
18 |
17 |
$0.00 |