| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
794 |
794 |
$86K |
| 92340 |
|
1,614 |
1,610 |
$48K |
| 92004 |
|
357 |
357 |
$47K |
| 92015 |
|
1,725 |
1,722 |
$31K |
| V2020 |
Frames, purchases |
1,542 |
1,540 |
$15K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
549 |
548 |
$15K |
| V2101 |
Sphere, single vision, plus or minus 4.12 to plus or minus 7.00d, per lens |
424 |
422 |
$12K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
232 |
232 |
$6K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,618 |
1,615 |
$0.00 |