| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
1,017 |
1,011 |
$15K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
561 |
558 |
$13K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
129 |
129 |
$6K |
| V2781 |
Progressive lens per lens |
159 |
158 |
$4K |
| S0620 |
Routine ophthalmological exa |
65 |
65 |
$3K |
| V2100 |
Lens spher single plano 4.00 |
107 |
106 |
$2K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
80 |
80 |
$2K |
| V2107 |
Spherocylinder 4.25d/12-2d |
52 |
52 |
$1K |
| V2784 |
Lens polycarb or equal |
112 |
108 |
$470.82 |
| V2744 |
Tint photochromatic lens/es |
49 |
49 |
$0.00 |
| V2799 |
Misc vision item or service |
29 |
26 |
$0.00 |
| V2750 |
Anti-reflective coating |
133 |
132 |
$0.00 |