| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92004 |
|
4,100 |
4,078 |
$200K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
6,460 |
3,958 |
$98K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
390 |
386 |
$83K |
| V2020 |
Frames, purchases |
5,091 |
5,033 |
$39K |
| 92285 |
|
1,308 |
1,303 |
$27K |
| 92340 |
|
1,582 |
1,568 |
$21K |
| 92250 |
|
382 |
382 |
$16K |
| 92015 |
|
976 |
975 |
$12K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
554 |
545 |
$4K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
124 |
90 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
268 |
252 |
$2K |
| 92014 |
|
40 |
40 |
$2K |
| 92341 |
|
30 |
29 |
$540.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,818 |
904 |
$270.00 |