| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
10,421 |
10,366 |
$218K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
6,216 |
6,135 |
$133K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
6,597 |
6,571 |
$77K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,677 |
1,656 |
$30K |
| V2750 |
Anti-reflective coating, per lens |
599 |
598 |
$11K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
245 |
245 |
$7K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
302 |
301 |
$5K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
132 |
132 |
$3K |
| V2025 |
Deluxe frame |
39 |
39 |
$2K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
41 |
41 |
$1K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$268.36 |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$260.06 |
| V2744 |
Tint, photochromatic, per lens |
12 |
12 |
$161.42 |