| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
19,454 |
9,826 |
$167K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
12,178 |
5,898 |
$118K |
| V2100 |
Lens spher single plano 4.00 |
4,377 |
2,148 |
$38K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
1,443 |
914 |
$34K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
2,268 |
1,128 |
$19K |
| V2107 |
Spherocylinder 4.25d/12-2d |
1,265 |
676 |
$12K |
| V2200 |
Lens spher bifoc plano 4.00d |
171 |
91 |
$2K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
97 |
54 |
$840.00 |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
132 |
55 |
$830.00 |
| 92340 |
|
12 |
12 |
$336.00 |
| 92015 |
|
13 |
13 |
$213.46 |
| V2799 |
Misc vision item or service |
601 |
272 |
$60.00 |