| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
269 |
159 |
$49K |
| V2025 |
Deluxe frame |
274 |
166 |
$24K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
474 |
325 |
$19K |
| V2755 |
U-v lens, per lens |
475 |
326 |
$14K |
| V2750 |
Anti-reflective coating, per lens |
452 |
313 |
$12K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
515 |
356 |
$10K |
| V2020 |
Frames, purchases |
201 |
168 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
105 |
66 |
$5K |
| V2115 |
Lenticular, (myodisc), per lens, single vision |
24 |
16 |
$3K |