| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
3,147 |
3,147 |
$322K |
| 92004 |
|
880 |
880 |
$108K |
| 92340 |
|
3,096 |
3,086 |
$92K |
| 92015 |
|
4,290 |
4,288 |
$76K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,695 |
1,684 |
$38K |
| V2020 |
Frames, purchases |
3,244 |
3,234 |
$32K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
313 |
312 |
$7K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
223 |
221 |
$5K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,259 |
3,239 |
$14.15 |