| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Deluxe frame |
1,980 |
1,546 |
$184K |
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
2,031 |
1,543 |
$139K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,229 |
940 |
$54K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
2,142 |
1,629 |
$39K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,174 |
1,651 |
$35K |
| V2750 |
Anti-reflective coating, per lens |
1,926 |
1,518 |
$25K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
34 |
27 |
$1K |
| V2020 |
Frames, purchases |
13 |
13 |
$459.16 |