| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
1,567 |
1,486 |
$68K |
| 92004 |
|
656 |
632 |
$41K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,369 |
1,291 |
$38K |
| 92015 |
|
2,199 |
2,101 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
407 |
389 |
$12K |
| V2020 |
Frames, purchases |
1,671 |
1,597 |
$11K |
| 92340 |
|
2,049 |
1,949 |
$11K |
| V2025 |
Deluxe frame |
426 |
396 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
15 |
13 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
75 |
70 |
$0.00 |