| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
766 |
763 |
$32K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,196 |
606 |
$25K |
| V2020 |
Frames, purchases |
1,162 |
1,154 |
$16K |
| 92004 |
|
211 |
211 |
$8K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
265 |
136 |
$5K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
179 |
90 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,330 |
1,158 |
$0.00 |