| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,616 |
1,533 |
$36K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
211 |
134 |
$5K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
766 |
742 |
$4K |
| 92341 |
|
176 |
166 |
$2K |
| V2756 |
Eye glass case |
1,604 |
1,532 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
228 |
192 |
$835.85 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
133 |
123 |
$300.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
112 |
107 |
$134.60 |