| 28666-6 | Right eye HSA distance (phoropter) |
| 28709-4 | Left eye HSA distance (phoropter) |
| 28783-9 | Right glasses lens HSA distance (lensmeter) |
| 28790-4 | Left glasses lens HSA distance (lensmeter) |
| 28830-8 | Right glasses lens prescription HSA distance |
| 28846-4 | Left glasses lens prescription HSA distance |