| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92340 |
|
5,295 |
5,215 |
$91K |
| 92014 |
|
822 |
799 |
$41K |
| 92015 |
|
988 |
972 |
$32K |
| 92004 |
|
36 |
36 |
$3K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
3,595 |
3,524 |
$220.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
2,014 |
1,973 |
$0.00 |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,276 |
1,256 |
$0.00 |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
42 |
40 |
$0.00 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
104 |
99 |
$0.00 |
| V2020 |
Frames, purchases |
4,089 |
3,986 |
$0.00 |