| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
997 |
997 |
$83K |
| 92014 |
|
915 |
912 |
$67K |
| 92340 |
|
1,817 |
1,809 |
$37K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
790 |
785 |
$29K |
| V2020 |
Frames, purchases |
1,133 |
1,131 |
$22K |
| 92012 |
|
196 |
196 |
$14K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
447 |
446 |
$13K |
| 92015 |
|
2,023 |
2,021 |
$8K |
| 92083 |
|
131 |
129 |
$7K |
| V2025 |
Deluxe frame |
267 |
265 |
$6K |
| 92283 |
|
131 |
130 |
$5K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
421 |
420 |
$4K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
55 |
55 |
$441.28 |