| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,649 |
2,524 |
$91K |
| 92014 |
|
1,342 |
1,269 |
$88K |
| 92004 |
|
1,004 |
955 |
$88K |
| 92340 |
|
2,322 |
2,225 |
$65K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,890 |
1,811 |
$34K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,670 |
1,594 |
$13K |
| V2782 |
Lens, index 1.54 to 1.65 plastic or 1.60 to 1.79 glass, excludes polycarbonate, per lens |
367 |
365 |
$11K |
| 92015 |
|
2,559 |
2,424 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
362 |
347 |
$7K |
| V2755 |
U-v lens, per lens |
382 |
380 |
$5K |
| V2760 |
Scratch resistant coating, per lens |
1,983 |
1,903 |
$4K |
| 99213 |
|
26 |
24 |
$1K |
| 92370 |
|
13 |
13 |
$349.45 |