| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
4,603 |
4,190 |
$368K |
| V2020 |
Frames, purchases |
4,597 |
4,129 |
$133K |
| 92004 |
|
1,377 |
1,226 |
$124K |
| 92015 |
|
7,911 |
7,192 |
$100K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,258 |
1,133 |
$56K |
| V2755 |
U-v lens, per lens |
2,144 |
1,900 |
$45K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
631 |
597 |
$18K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
16 |
15 |
$739.30 |