| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
1,940 |
1,930 |
$78K |
| V2020 |
Frames, purchases |
3,033 |
2,435 |
$67K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,845 |
1,046 |
$59K |
| 92004 |
|
1,402 |
1,385 |
$56K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
788 |
527 |
$32K |
| S0500 |
Disposable contact lens, per lens |
191 |
191 |
$15K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
114 |
77 |
$5K |
| V2599 |
Contact lens, other type |
29 |
29 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
77 |
57 |
$933.76 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
25 |
13 |
$820.37 |
| V2750 |
Anti-reflective coating, per lens |
55 |
26 |
$156.00 |
| V2799 |
Vision item or service, miscellaneous |
14 |
14 |
$70.00 |