| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
3,712 |
2,539 |
$108K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,907 |
1,432 |
$77K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
890 |
454 |
$23K |
| 92004 |
|
339 |
337 |
$17K |
| 92014 |
|
278 |
278 |
$14K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
520 |
277 |
$13K |
| V2750 |
Anti-reflective coating, per lens |
102 |
53 |
$726.80 |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
28 |
16 |
$697.02 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
16 |
13 |
$305.00 |