| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
2,292 |
2,192 |
$218K |
| 92014 |
|
2,244 |
2,157 |
$179K |
| 92340 |
|
2,480 |
2,409 |
$154K |
| V2020 |
Frames, purchases |
2,154 |
2,133 |
$106K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,646 |
1,498 |
$24K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
139 |
139 |
$9K |
| 92250 |
|
42 |
39 |
$722.38 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
37 |
35 |
$696.26 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
18 |
18 |
$397.44 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
14 |
14 |
$178.41 |
| V2760 |
Scratch resistant coating, per lens |
19 |
19 |
$0.00 |