| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,548 |
2,945 |
$140K |
| 92014 |
|
4,497 |
3,790 |
$129K |
| 92004 |
|
1,552 |
1,325 |
$79K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,093 |
874 |
$39K |
| V2020 |
Frames, purchases |
3,684 |
3,069 |
$28K |
| 92015 |
|
5,711 |
4,850 |
$28K |
| 92340 |
|
5,057 |
4,156 |
$26K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
320 |
272 |
$15K |
| V2599 |
Contact lens, other type |
85 |
70 |
$10K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
305 |
250 |
$8K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
94 |
75 |
$4K |
| 92341 |
|
386 |
335 |
$1K |
| 92310 |
|
230 |
209 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
630 |
525 |
$170.00 |
| V2750 |
Anti-reflective coating, per lens |
93 |
63 |
$0.00 |
| V2025 |
Deluxe frame |
2,161 |
1,813 |
$-443.00 |