| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
2,665 |
2,456 |
$114K |
| 92015 |
|
4,314 |
3,973 |
$77K |
| 92340 |
|
2,609 |
2,228 |
$76K |
| 92004 |
|
1,648 |
1,527 |
$75K |
| V2025 |
Deluxe frame |
1,599 |
1,443 |
$52K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
2,527 |
2,175 |
$43K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,202 |
1,856 |
$18K |
| V2020 |
Frames, purchases |
1,759 |
1,511 |
$17K |
| 92341 |
|
348 |
301 |
$10K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
374 |
331 |
$9K |
| 99212 |
|
100 |
97 |
$3K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
207 |
182 |
$2K |
| 92250 |
|
44 |
38 |
$2K |
| 92012 |
|
17 |
17 |
$765.00 |