| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
1,864 |
1,711 |
$86K |
| 92340 |
|
1,934 |
1,821 |
$57K |
| 92015 |
|
3,091 |
2,919 |
$56K |
| 92014 |
|
1,257 |
1,189 |
$56K |
| V2025 |
Deluxe frame |
1,840 |
1,725 |
$53K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,195 |
1,111 |
$11K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
847 |
812 |
$11K |
| V2523 |
Contact lens, hydrophilic, extended wear, per lens |
106 |
102 |
$10K |
| 92310 |
|
200 |
173 |
$9K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
119 |
113 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
75 |
73 |
$975.00 |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
39 |
38 |
$592.00 |