| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,332 |
4,238 |
$145K |
| V2025 |
Deluxe frame |
2,055 |
2,055 |
$102K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,768 |
2,698 |
$84K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
3,209 |
3,202 |
$53K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
437 |
428 |
$22K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,004 |
1,999 |
$16K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,698 |
1,693 |
$4K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
144 |
144 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
174 |
173 |
$1K |
| V2750 |
Anti-reflective coating, per lens |
77 |
77 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
26 |
26 |
$0.00 |