| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
4,045 |
3,653 |
$159K |
| 92340 |
|
5,588 |
4,628 |
$93K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
6,842 |
5,879 |
$86K |
| V2020 |
Frames, purchases |
7,302 |
6,331 |
$79K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,886 |
4,934 |
$50K |
| 92004 |
|
343 |
340 |
$14K |
| 92015 |
|
2,869 |
2,676 |
$11K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
89 |
84 |
$189.00 |
| V2781 |
Progressive lens, per lens |
136 |
125 |
$0.00 |
| V2744 |
Tint, photochromatic, per lens |
136 |
125 |
$0.00 |
| 92250 |
|
538 |
387 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
169 |
115 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
370 |
324 |
$0.00 |
| S0590 |
Integral lens service, miscellaneous services reported separately |
52 |
51 |
$0.00 |