| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,073 |
1,965 |
$132K |
| V2020 |
Frames, purchases |
2,573 |
2,430 |
$97K |
| 92004 |
|
515 |
489 |
$33K |
| 92015 |
|
3,487 |
3,307 |
$28K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
590 |
563 |
$17K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
379 |
359 |
$16K |
| 92012 |
|
132 |
127 |
$2K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
24 |
24 |
$2K |
| 92002 |
|
43 |
42 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
19 |
14 |
$807.56 |
| 92250 |
|
12 |
12 |
$10.34 |