Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens
Short Description: Lens sphcy bifocal 4.00d/4.2
Coverage Code: Carrier judgment
Action Code: No maintenance for this code
Date Added: January 1, 1985
Effective Date: October 1, 2003
Termination Date: