| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
4,395 |
1,846 |
$133K |
| V2020 |
Frames, purchases |
4,368 |
3,130 |
$92K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
606 |
364 |
$27K |
| S0500 |
Disposable contact lens, per lens |
358 |
304 |
$24K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
425 |
236 |
$17K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
237 |
107 |
$7K |
| V2750 |
Anti-reflective coating, per lens |
2,652 |
1,181 |
$5K |
| S0581 |
Nonstandard lens (list this code in addition to the basic code for the lens) |
98 |
49 |
$4K |
| V2599 |
Contact lens, other type |
31 |
31 |
$3K |
| V2744 |
Tint, photochromatic, per lens |
354 |
165 |
$1K |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
14 |
13 |
$985.24 |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
29 |
16 |
$955.50 |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
18 |
15 |
$190.00 |