| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
594 |
590 |
$36K |
| 92250 |
|
780 |
776 |
$34K |
| V2020 |
Frames, purchases |
2,081 |
2,000 |
$27K |
| 92004 |
|
349 |
347 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
989 |
582 |
$15K |
| 92083 |
|
245 |
244 |
$11K |
| V2783 |
Lens, index greater than or equal to 1.66 plastic or greater than or equal to 1.80 glass, excludes polycarbonate, per lens |
39 |
37 |
$11K |
| 92285 |
|
138 |
137 |
$3K |
| 92202 |
|
53 |
53 |
$1K |
| 92133 |
|
40 |
40 |
$1K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
214 |
131 |
$1K |
| 92225 |
|
41 |
41 |
$755.09 |
| 92286 |
|
12 |
12 |
$703.04 |
| 92340 |
|
26 |
26 |
$345.95 |
| 76514 |
|
29 |
29 |
$255.95 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
43 |
29 |
$102.00 |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
13 |
13 |
$18.00 |