| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
6,058 |
3,157 |
$87K |
| V2020 |
Frames, purchases |
4,461 |
4,375 |
$64K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
1,636 |
901 |
$34K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
4,015 |
2,003 |
$2K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
184 |
92 |
$1K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
34 |
17 |
$171.48 |