| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
417 |
413 |
$21K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
92 |
89 |
$10K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
204 |
201 |
$8K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
265 |
261 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
161 |
161 |
$6K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
63 |
62 |
$2K |
| 92341 |
|
13 |
13 |
$347.20 |
| V2750 |
Anti-reflective coating, per lens |
15 |
15 |
$45.00 |