| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,576 |
4,752 |
$245K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,235 |
1,917 |
$66K |
| 92340 |
|
5,742 |
4,900 |
$46K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
746 |
635 |
$25K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,880 |
2,470 |
$15K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
223 |
185 |
$13K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
34 |
28 |
$3K |
| 92341 |
|
284 |
257 |
$3K |
| V2730 |
Special base curve, glass or plastic, per lens |
157 |
138 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
35 |
31 |
$2K |
| V2025 |
Deluxe frame |
216 |
188 |
$2K |
| V2755 |
U-v lens, per lens |
156 |
144 |
$1K |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
163 |
154 |
$397.92 |