| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,564 |
2,341 |
$137K |
| V2020 |
Frames, purchases |
4,198 |
3,753 |
$110K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,280 |
589 |
$23K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
474 |
245 |
$6K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
184 |
115 |
$4K |
| V2781 |
Progressive lens, per lens |
48 |
25 |
$1K |