| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
3,953 |
3,832 |
$176K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
5,767 |
1,961 |
$156K |
| V2020 |
Frames, purchases |
3,931 |
2,790 |
$154K |
| 92014 |
|
409 |
402 |
$16K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
312 |
170 |
$12K |
| 92340 |
|
694 |
685 |
$7K |
| V2500 |
Contact lens, pmma, spherical, per lens |
52 |
52 |
$4K |
| 92310 |
|
100 |
96 |
$3K |
| V2520 |
Contact lens, hydrophilic, spherical, per lens |
28 |
28 |
$3K |
| 92015 |
|
410 |
404 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
55 |
17 |
$8.00 |