| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
1,267 |
1,222 |
$114K |
| 92014 |
|
1,372 |
1,338 |
$92K |
| 92340 |
|
1,419 |
1,352 |
$41K |
| 92015 |
|
2,861 |
2,760 |
$35K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,168 |
1,068 |
$33K |
| V2020 |
Frames, purchases |
1,978 |
1,714 |
$22K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,031 |
941 |
$14K |
| V2760 |
Scratch resistant coating, per lens |
692 |
689 |
$13K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
102 |
74 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
57 |
52 |
$608.00 |