| 28718-5 | Right eye HSA N (phoropter) |
| 28730-0 | Left eye HSA N (phoropter) |
| 28800-1 | Right glasses lens HSA N (lensmeter) |
| 28809-2 | Left glasses lens HSA N (lensmeter) |
| 28838-1 | Right glasses lens prescription HSA N |
| 28855-5 | Left glasses lens prescription HSA N |