| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
1,351 |
1,077 |
$149K |
| V2025 |
Deluxe frame |
1,146 |
905 |
$101K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,349 |
1,077 |
$42K |
| V2750 |
Anti-reflective coating, per lens |
1,350 |
1,076 |
$38K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
384 |
307 |
$29K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,183 |
942 |
$25K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
271 |
227 |
$18K |
| V2108 |
Spherocylinder, single vision, plus or minus 4.25d to plus or minus 7.00d sphere, 2.12 to 4.00d cylinder, per lens |
12 |
12 |
$1K |
| 01715 |
|
36 |
32 |
$0.00 |