| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
462 |
285 |
$4K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
154 |
95 |
$3K |
| V2799 |
Vision item or service, miscellaneous |
359 |
268 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
26 |
12 |
$792.00 |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
82 |
78 |
$192.66 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
24 |
13 |
$0.00 |
| V2025 |
Deluxe frame |
27 |
15 |
$0.00 |