| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
5,432 |
5,412 |
$235K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
8,376 |
8,299 |
$137K |
| V2020 |
Frames, purchases |
3,872 |
3,616 |
$129K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,460 |
4,388 |
$41K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
5,423 |
5,372 |
$34K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,283 |
1,281 |
$30K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,030 |
912 |
$21K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
214 |
214 |
$10K |
| V2750 |
Anti-reflective coating, per lens |
2,058 |
2,050 |
$10K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
1,575 |
1,565 |
$9K |
| V2105 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens |
231 |
227 |
$2K |
| 92341 |
|
32 |
27 |
$969.30 |
| V2744 |
Tint, photochromatic, per lens |
36 |
36 |
$180.00 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
52 |
51 |
$0.00 |