| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
3,449 |
3,253 |
$419K |
| 92014 |
|
4,072 |
3,765 |
$348K |
| V2025 |
Deluxe frame |
2,420 |
2,248 |
$219K |
| 92004 |
|
2,064 |
1,873 |
$191K |
| 92250 |
|
6,022 |
5,522 |
$182K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,578 |
4,303 |
$121K |
| V2750 |
Anti-reflective coating, per lens |
4,552 |
4,283 |
$103K |
| V2020 |
Frames, purchases |
1,776 |
1,711 |
$84K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,301 |
2,163 |
$84K |
| 92340 |
|
4,438 |
4,178 |
$67K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
493 |
458 |
$16K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
155 |
146 |
$4K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
30 |
26 |
$825.00 |
| 92015 |
|
6,835 |
6,246 |
$422.76 |