| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2219 |
Bifocal seg width over 28 mm |
620 |
588 |
$51K |
| V2020 |
Frames, purchases |
2,925 |
2,867 |
$42K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,080 |
538 |
$12K |
| 92341 |
|
646 |
615 |
$12K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
443 |
222 |
$8K |
| V2430 |
Variable asphericity lens, bifocal, full field, glass or plastic, per lens |
110 |
108 |
$7K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
107 |
107 |
$6K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
333 |
280 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
450 |
261 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,118 |
1,057 |
$1K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
26 |
26 |
$351.00 |
| V2755 |
U-v lens, per lens |
624 |
312 |
$0.00 |