| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Frames, purchases |
987 |
981 |
$3K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
1,445 |
778 |
$2K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
447 |
235 |
$436.62 |
| V2200 |
Sphere, bifocal, plano to plus or minus 4.00d, per lens |
26 |
15 |
$78.00 |
| V2103 |
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens |
98 |
49 |
$0.00 |
| V2599 |
Contact lens, other type |
12 |
12 |
$0.00 |
| V2500 |
Contact lens, pmma, spherical, per lens |
63 |
63 |
$0.00 |