| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
5,495 |
3,747 |
$216K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
3,591 |
2,468 |
$155K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,618 |
3,850 |
$147K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
5,924 |
3,942 |
$102K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,191 |
803 |
$48K |
| V2025 |
Deluxe frame |
209 |
144 |
$20K |
| V2750 |
Anti-reflective coating, per lens |
373 |
307 |
$12K |
| V2744 |
Tint, photochromatic, per lens |
333 |
299 |
$9K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
96 |
66 |
$4K |