| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
861 |
826 |
$29K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
729 |
699 |
$9K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
696 |
667 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
921 |
883 |
$405.00 |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
924 |
886 |
$0.00 |
| V2025 |
Deluxe frame |
28 |
27 |
$0.00 |
| V2755 |
U-v lens, per lens |
924 |
886 |
$0.00 |