| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
999 |
894 |
$37K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
678 |
599 |
$23K |
| V2020 |
Frames, purchases |
916 |
820 |
$7K |
| 92004 |
|
102 |
100 |
$6K |
| 92015 |
|
1,442 |
1,305 |
$6K |
| 92340 |
|
1,173 |
1,049 |
$6K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
65 |
61 |
$820.50 |
| V2025 |
Deluxe frame |
127 |
111 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
13 |
13 |
$0.00 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
69 |
62 |
$0.00 |