| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2755 |
U-v lens, per lens |
3,967 |
3,070 |
$68K |
| V2020 |
Frames, purchases |
2,745 |
2,534 |
$51K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,436 |
1,125 |
$48K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
649 |
484 |
$19K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
573 |
464 |
$19K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
153 |
114 |
$5K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
83 |
55 |
$3K |