| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| V2020 |
Vision svcs frames purchases |
47,642 |
47,498 |
$247K |
| V2103 |
Spherocylindr 4.00d/12-2.00d |
45,004 |
26,338 |
$179K |
| V2784 |
Lens polycarb or equal |
81,701 |
40,720 |
$163K |
| V2203 |
Lens sphcyl bifocal 4.00d/.1 |
15,620 |
9,038 |
$93K |
| V2100 |
Lens spher single plano 4.00 |
16,088 |
10,721 |
$64K |
| V2104 |
Spherocylindr 4.00d/2.12-4d |
5,670 |
3,946 |
$28K |
| V2200 |
Lens spher bifoc plano 4.00d |
4,234 |
3,046 |
$25K |
| V2107 |
Spherocylinder 4.25d/12-2d |
4,680 |
3,098 |
$23K |
| V2744 |
Tint photochromatic lens/es |
1,828 |
913 |
$14K |
| V2204 |
Lens sphcy bifocal 4.00d/2.1 |
1,015 |
773 |
$7K |
| V2207 |
Lens sphcy bifocal 4.25-7d/. |
982 |
668 |
$7K |
| V2111 |
Spherocylindr 7.25d/.25-2.25 |
687 |
475 |
$5K |
| V2108 |
Spherocylinder 4.25d/2.12-4d |
1,014 |
748 |
$5K |
| V2101 |
Single visn sphere 4.12-7.00 |
972 |
723 |
$5K |
| V2105 |
Spherocylinder 4.00d/4.25-6d |
870 |
630 |
$4K |
| V2303 |
Lens sphcy trifocal 4.0/.12- |
211 |
118 |
$2K |
| V2783 |
Lens, >= 1.66 p/>=1.80 g |
230 |
113 |
$2K |
| V2715 |
Prism lens/es |
1,316 |
702 |
$1K |
| V2112 |
Spherocylindr 7.25d/2.25-4d |
110 |
82 |
$654.00 |
| V2211 |
Lens sphcy bifo 7.25-12/.25- |
45 |
27 |
$405.00 |
| V2109 |
Spherocylinder 4.25d/4.25-6d |
52 |
41 |
$260.00 |
| V2102 |
Singl visn sphere 7.12-20.00 |
17 |
13 |
$102.00 |
| V2745 |
Tint, any color/solid/grad |
190 |
190 |
$100.00 |
| V2750 |
Anti-reflective coating |
480 |
478 |
$0.00 |
| V2781 |
Progressive lens per lens |
1,273 |
634 |
$0.00 |
| V2780 |
Oversize lens/es |
13 |
13 |
$0.00 |