| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
3,829 |
3,521 |
$164K |
| 92015 |
|
6,427 |
5,899 |
$114K |
| 92004 |
|
2,389 |
2,191 |
$108K |
| 92340 |
|
2,897 |
2,649 |
$84K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,880 |
2,657 |
$47K |
| V2025 |
Deluxe frame |
1,386 |
1,296 |
$46K |
| V2020 |
Frames, purchases |
2,186 |
2,006 |
$21K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,236 |
2,039 |
$18K |
| 92341 |
|
215 |
190 |
$6K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
225 |
199 |
$5K |
| 92250 |
|
49 |
48 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
77 |
63 |
$928.56 |