| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
235,947 |
220,423 |
$1.20M |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
240,995 |
131,230 |
$956K |
| V2784 |
Lens polycarb or equal |
385,606 |
180,670 |
$764K |
| V2100 |
Lens spher single plano 4.00 |
107,766 |
63,697 |
$428K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
37,412 |
23,757 |
$186K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
30,876 |
17,033 |
$182K |
| V2107 |
Spherocylinder 4.25d/12-2d |
24,245 |
14,815 |
$120K |
| V2200 |
Lens spher bifoc plano 4.00d |
10,008 |
6,537 |
$59K |
| V2744 |
Tint photochromatic lens/es |
6,004 |
2,976 |
$58K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
6,578 |
4,434 |
$33K |
| V2101 |
Single visn sphere 4.12-7.00 |
6,584 |
4,429 |
$33K |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
1,988 |
979 |
$30K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
5,850 |
4,043 |
$29K |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
3,453 |
2,215 |
$27K |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
2,384 |
1,666 |
$16K |
| V2207 |
Lens sphcy bifocal 4.25-7d/. |
2,098 |
1,366 |
$14K |
| V2112 |
Spherocylindr 7.25d/2.25-4d |
1,459 |
1,006 |
$9K |
| V2109 |
Spherocylinder 4.25d/4.25-6d |
1,487 |
1,026 |
$7K |
| V2303 |
Lens sphcy trifocal 4.0/.12- |
438 |
244 |
$5K |
| V2750 |
Anti-reflective coating |
2,442 |
2,419 |
$4K |
| V2102 |
Singl visn sphere 7.12-20.00 |
572 |
367 |
$3K |
| V2715 |
Prism lens/es |
2,930 |
1,535 |
$3K |
| V2211 |
Lens sphcy bifo 7.25-12/.25- |
285 |
181 |
$2K |
| V2114 |
Spherocylinder over 12.00d |
253 |
153 |
$2K |
| V2208 |
Lens sphcy bifocal 4.25-7/2. |
281 |
194 |
$2K |
| V2781 |
Progressive lens per lens |
3,960 |
1,962 |
$2K |
| V2201 |
Lens sphere bifocal 4.12-7.0 |
233 |
165 |
$2K |
| V2782 |
Lens, 1.54-1.65 p/1.60-1.79g |
125 |
63 |
$855.00 |
| V2205 |
Lens sphcy bifocal 4.00d/4.2 |
73 |
55 |
$504.00 |
| V2745 |
Tint, any color/solid/grad |
418 |
412 |
$436.00 |
| V2300 |
Lens sphere trifocal 4.00d |
20 |
14 |
$208.00 |
| V2106 |
Spherocylinder 4.00d/>6.00d |
33 |
26 |
$198.00 |
| V2212 |
Lens sphcyl bifo 7.25-12/2.2 |
18 |
12 |
$162.00 |
| V2113 |
Spherocylindr 7.25d/4.25-6d |
18 |
14 |
$144.00 |
| V2780 |
Oversize lens/es |
133 |
133 |
$124.00 |
| V2797 |
Vis item/svc in other code |
41 |
31 |
$122.00 |
| V2799 |
Misc vision item or service |
28 |
13 |
$112.00 |