| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,472 |
2,237 |
$220K |
| V2020 |
Frames, purchases |
3,992 |
3,561 |
$124K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,518 |
3,124 |
$105K |
| 92004 |
|
1,003 |
851 |
$101K |
| 92340 |
|
3,861 |
3,437 |
$66K |
| 92015 |
|
3,797 |
3,369 |
$57K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
877 |
867 |
$17K |
| V2750 |
Anti-reflective coating, per lens |
57 |
45 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
14 |
14 |
$402.09 |