| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,410 |
3,223 |
$141K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,654 |
1,307 |
$71K |
| V2755 |
U-v lens, per lens |
2,235 |
1,752 |
$37K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
501 |
391 |
$18K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
75 |
60 |
$4K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
15 |
14 |
$0.00 |