| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
4,013 |
3,870 |
$78K |
| V2025 |
Deluxe frame |
926 |
894 |
$62K |
| 99211 |
|
3,252 |
3,105 |
$41K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,584 |
1,521 |
$29K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,526 |
1,475 |
$29K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
342 |
330 |
$18K |
| S0580 |
Polycarbonate lens (list this code in addition to the basic code for the lens) |
34 |
32 |
$701.40 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
12 |
12 |
$236.10 |