| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
2,428 |
2,420 |
$175K |
| 92250 |
|
3,247 |
3,239 |
$149K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,877 |
2,472 |
$69K |
| V2020 |
Frames, purchases |
4,755 |
4,695 |
$64K |
| 92014 |
|
643 |
637 |
$36K |
| 92285 |
|
1,378 |
1,369 |
$33K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
441 |
336 |
$11K |
| 92015 |
|
685 |
681 |
$8K |
| 92012 |
|
169 |
165 |
$6K |
| 92340 |
|
428 |
424 |
$6K |
| 92225 |
|
311 |
181 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
517 |
377 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
936 |
652 |
$3K |
| 92133 |
|
75 |
75 |
$2K |
| V2219 |
Bifocal seg width over 28 mm |
12 |
12 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
23 |
15 |
$550.06 |
| 92134 |
|
28 |
28 |
$390.26 |
| 92341 |
|
13 |
13 |
$240.00 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
55 |
55 |
$180.00 |
| 76514 |
|
24 |
24 |
$151.81 |
| V2755 |
U-v lens, per lens |
330 |
164 |
$0.00 |