| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
1,017 |
1,011 |
$15K |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
561 |
558 |
$13K |
| V2203 |
Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
129 |
129 |
$6K |
| V2781 |
Progressive lens, per lens |
159 |
158 |
$4K |
| S0620 |
Routine ophthalmological examination including refraction; new patient |
65 |
65 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
107 |
106 |
$2K |
| V2104 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens |
80 |
80 |
$2K |
| V2107 |
Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens |
52 |
52 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
112 |
108 |
$470.82 |
| V2744 |
Tint, photochromatic, per lens |
49 |
49 |
$0.00 |
| V2799 |
Vision item or service, miscellaneous |
29 |
26 |
$0.00 |
| V2750 |
Anti-reflective coating, per lens |
133 |
132 |
$0.00 |