| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
3,275 |
3,077 |
$361K |
| V2020 |
Frames, purchases |
5,349 |
5,013 |
$203K |
| V2755 |
U-v lens, per lens |
4,729 |
4,457 |
$108K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,469 |
1,419 |
$71K |
| V2430 |
Variable asphericity lens, bifocal, full field, glass or plastic, per lens |
35 |
28 |
$4K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
32 |
30 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
13 |
13 |
$783.53 |