| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
3,118 |
1,593 |
$52K |
| V2020 |
Frames, purchases |
2,844 |
2,825 |
$29K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
476 |
475 |
$7K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
365 |
195 |
$2K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
97 |
49 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,035 |
1,020 |
$208.00 |
| V2755 |
U-v lens, per lens |
2,536 |
1,263 |
$0.00 |