| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
2,022 |
1,952 |
$60K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
1,478 |
1,436 |
$44K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
1,098 |
1,057 |
$19K |
| V2755 |
U-v lens, per lens |
1,080 |
1,055 |
$15K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
1,610 |
1,560 |
$12K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
374 |
363 |
$6K |
| 92341 |
|
114 |
112 |
$4K |
| V2760 |
Scratch resistant coating, per lens |
1,635 |
1,584 |
$3K |
| V2750 |
Anti-reflective coating, per lens |
189 |
185 |
$2K |
| 92370 |
|
14 |
14 |
$319.00 |
| 99199 |
Unlisted special service, procedure or report |
17 |
13 |
$0.00 |