| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2410 |
Variable asphericity lens, single vision, full field, glass or plastic, per lens |
944 |
541 |
$171K |
| V2020 |
Frames, purchases |
2,287 |
1,373 |
$106K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
2,157 |
1,291 |
$82K |
| 92014 |
|
681 |
648 |
$67K |
| V2750 |
Anti-reflective coating, per lens |
1,956 |
1,144 |
$54K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
782 |
448 |
$42K |
| 92340 |
|
1,851 |
1,096 |
$37K |
| 92004 |
|
267 |
247 |
$29K |
| 92250 |
|
203 |
197 |
$12K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
22 |
12 |
$1K |
| 92015 |
|
22 |
20 |
$0.00 |