| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
7,290 |
6,662 |
$394K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,870 |
1,614 |
$162K |
| 92341 |
|
2,206 |
2,169 |
$74K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,024 |
1,968 |
$74K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,393 |
1,309 |
$74K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,478 |
2,446 |
$70K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,115 |
1,103 |
$41K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
113 |
112 |
$7K |
| V2745 |
Addition to lens; tint, any color, solid, gradient or equal, excludes photochromatic, any lens material, per lens |
183 |
146 |
$2K |
| V2760 |
Scratch resistant coating, per lens |
146 |
146 |
$1K |
| V2025 |
Deluxe frame |
167 |
167 |
$0.00 |