| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,956 |
5,239 |
$175K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
7,906 |
7,048 |
$125K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,287 |
2,808 |
$81K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,603 |
1,450 |
$51K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
765 |
729 |
$15K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
222 |
207 |
$7K |
| V2750 |
Anti-reflective coating, per lens |
147 |
145 |
$3K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
22 |
13 |
$394.56 |