| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,998 |
2,669 |
$171K |
| V2750 |
Anti-reflective coating, per lens |
1,581 |
1,347 |
$121K |
| 92340 |
|
5,359 |
4,747 |
$81K |
| 92004 |
|
1,035 |
945 |
$72K |
| V2020 |
Frames, purchases |
5,090 |
4,511 |
$58K |
| 92015 |
|
5,057 |
4,518 |
$38K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,749 |
2,372 |
$32K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,116 |
1,857 |
$18K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,211 |
1,144 |
$10K |
| V2499 |
Variable sphericity lens, other type |
80 |
70 |
$5K |
| 92250 |
|
13 |
12 |
$517.00 |