| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2025 |
Eyeglasses delux frames |
55,657 |
33,873 |
$988K |
| V2784 |
Lens polycarb or equal |
76,523 |
57,132 |
$775K |
| V2020 |
Vision svcs frames purchases |
40,238 |
36,845 |
$756K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
56,451 |
41,299 |
$704K |
| V2100 |
Lens spher single plano 4.00 |
14,209 |
11,228 |
$208K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
12,996 |
9,761 |
$145K |
| V2750 |
Anti-reflective coating |
16,145 |
11,841 |
$122K |
| V2781 |
Progressive lens per lens |
741 |
670 |
$28K |
| V2799 |
Misc vision item or service |
3,101 |
3,079 |
$23K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
852 |
663 |
$21K |
| V2107 |
Spherocylinder 4.25d/12-2d |
1,399 |
1,063 |
$16K |
| V2744 |
Tint photochromatic lens/es |
472 |
406 |
$6K |
| S0620 |
Routine ophthalmological exa |
199 |
186 |
$2K |
| 92002 |
|
90 |
86 |
$2K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
36 |
36 |
$773.38 |
| V2200 |
Lens spher bifoc plano 4.00d |
26 |
26 |
$641.92 |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
17 |
16 |
$268.66 |
| V2760 |
Scratch resistant coating |
220 |
215 |
$226.06 |
| V2797 |
Vis item/svc in other code |
747 |
671 |
$0.00 |
| 92260 |
|
12 |
12 |
$0.00 |